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Hernia : the Journal of Hernias and... Aug 2023A perineal hernia is a subtype of pelvic floor hernias, and especially primary perineal hernias are rare. No guideline exists on how to handle this type of hernia.... (Review)
Review
PURPOSE
A perineal hernia is a subtype of pelvic floor hernias, and especially primary perineal hernias are rare. No guideline exists on how to handle this type of hernia. Therefore, the primary aim of this scoping review was to investigate the surgical treatment options in adults for primary perineal hernias.
METHODS
This systematic scoping review included studies with original data on at least one adult operated for a primary perineal hernia. Studies from 1990 and forward were included to cover contemporary surgical techniques. Three databases were systematically searched: PubMed, Embase, and Cochrane CENTRAL. Furthermore, a snowball search was performed. The primary outcome was to narratively present details about the surgical techniques. The secondary outcomes were to give an overview of symptoms, diagnostics, intraoperative complications, and postoperative course.
RESULTS
Twenty-two case studies reported repairs on 22 patients suffering from primary perineal hernia. Common symptoms were pain and discomfort, and a bulge was often found during physical examination. Different diagnostic methods were used, and MRI-scans most often found an abnormality. Different surgical procedures can repair the condition, however, laparotomy and the use of a permanent mesh was the most common option. Far from all studies reported on outcomes, but no severe intraoperative event was reported, and the postoperative course was overall uneventful.
CONCLUSION
Primary perineal hernia is a very rare condition presenting with pain/discomfort and bulging and it can be visualized with different imaging modalities. Laparotomy with a permanent mesh was often used for repair, and the postoperative course was mostly uneventful.
Topics: Adult; Humans; Herniorrhaphy; Surgical Mesh; Hernia; Hernia, Abdominal; Laparotomy; Pain; Perineum
PubMed: 36840829
DOI: 10.1007/s10029-023-02760-9 -
International Urogynecology Journal Dec 2023Perineal wound dehiscence is associated with complications, such as infections, perineal pain, dyspareunia, and altered sexual function, that severely affects women's... (Meta-Analysis)
Meta-Analysis
INTRODUCTION AND HYPOTHESIS
Perineal wound dehiscence is associated with complications, such as infections, perineal pain, dyspareunia, and altered sexual function, that severely affects women's health. Currently, few studies have examined secondary repair of first- and second-degree perineal wound dehiscence and episiotomies, and there is currently no consensus on the optimal treatment option for dehisced perineal wounds. The objective was to evaluate whether resuturing or conservative treatment of first- and second-degree dehisced perineal wounds and episiotomies is the optimal treatment modality in terms of postoperative healing time and other secondary outcomes.
METHODS
A systematic literature search was carried out using PubMed, Embase, and Cochrane databases. All included studies were evaluated using the SIGN methodology checklist, with the purpose of assessing the study quality.
RESULTS
Three randomized controlled trials were included. Only two small sample-sized studies presented data regarding healing time for both the resuturing and the conservative treatment groups. However, no significant difference was found between the two groups at 4-6 weeks' healing time (RR 1.16, 95% CI 0.53-2.52). One study found that women being resutured experienced a significantly reduced healing time and higher satisfaction with the appearance of the wound healing at 3 months compared with the conservative treatment group.
CONCLUSION
We found no significant differences in the healing time between the resuturing group and the conservative treatment group. However, the sample sizes of the studies were small. A well-designed, large, and prospective randomized controlled trial is needed to evaluate the optimal treatment modality for dehisced perineal wounds.
Topics: Female; Humans; Pregnancy; Conservative Treatment; Delivery, Obstetric; Episiotomy; Perineum; Prospective Studies
PubMed: 37740731
DOI: 10.1007/s00192-023-05642-x -
Healthcare (Basel, Switzerland) Mar 2024Non-pharmaceutical midwifery techniques, including perineal warm compresses, to improve maternal outcomes remain controversial. The aims of this study are to assess the... (Review)
Review
Effects of Perineal Warm Compresses during the Second Stage of Labor on Reducing Perineal Trauma and Relieving Postpartum Perineal Pain in Primiparous Women: A Systematic Review and Meta-Analyses.
Non-pharmaceutical midwifery techniques, including perineal warm compresses, to improve maternal outcomes remain controversial. The aims of this study are to assess the effects of perineal warm compresses on reducing perineal trauma and postpartum perineal pain relief. This systematic review included randomized controlled trials (RCTs). We searched seven bibliographic databases, three RCT register websites, and two dissertation databases for publications from inception to 15 March 2023. Chinese and English publications were included. Two independent reviewers conducted the risk of bias assessment, data extraction, and the evaluation of the certainty of the evidence utilizing the Cochrane risk of bias 2.0 assessment criteria, the Review Manager 5.4, and the online GRADEpro tool, respectively. Seven RCTs involving 1362 primiparous women were included. The combined results demonstrated a statistically significant reduction in the second-, third- and/or fourth- degree perineal lacerations, the incidence of episiotomy, and the relief of the short-term perineal pain postpartum (within two days). There was a potential favorable effect on improving the integrity of the perineum. However, the results did not show a statistically significant supportive effect on reducing first-degree perineal lacerations and the rate of perineal lacerations requiring sutures. In summary, perineal warm compresses effectively reduced the second-, third-/or fourth-degree perineal trauma and decreased the short-term perineal pain after birth.
PubMed: 38610125
DOI: 10.3390/healthcare12070702 -
Journal of Robotic Surgery Jun 2024This study aims to compare the perioperative, oncological, and functional outcomes of perineal hydrodissection (HD) with standard treatment (ST) in patients undergoing... (Meta-Analysis)
Meta-Analysis Review
A systematic review and meta-analysis of the role of perineal hydrodissection in perioperative, oncologic, and functional outcomes for patients undergoing robot-assisted radical prostatectomy.
This study aims to compare the perioperative, oncological, and functional outcomes of perineal hydrodissection (HD) with standard treatment (ST) in patients undergoing robot-assisted radical prostatectomy. We performed an exhaustive search in databases such as PubMed, Embase, Web of Science, and the Cochrane Library, seeking English-language studies relevant to our research question, with a cutoff date of April 2024. The pooled results were assessed using the weighted mean differences (WMDs), standardized mean differences (SMDs), and odds ratios (ORs) metrics. We also performed a sensitivity analysis. The meta-analysis was conducted utilizing Stata/MP version 18 software. The study was registered with PROSPERO (ID: CRD 42024536400). We included a total of five studies (three RCTs and two retrospective studies). According to the data from the Meta-analysis, the HD group showed positive effects in promoting urinary continence (OR 2.64, 95% CI 1.36, 5.12; p = 0.004 < 0.05) and erectile function (SMD 0.92, 95%CI 0.56, 1.27; p < 0.05) within 3 months after surgery. However, no notable disparities were observed in terms of operative time, estimated blood loss, bilateral nerve-sparing rate, or the rate of positive surgical margin. Perineal hydrodissection can be safely applied in robot-assisted radical prostatectomy (RARP), offering a distinct advantage in functional outcomes compared to those who undergo standard robot-assisted prostatectomy alone.
Topics: Humans; Prostatectomy; Robotic Surgical Procedures; Male; Perineum; Prostatic Neoplasms; Treatment Outcome; Urinary Incontinence; Postoperative Complications
PubMed: 38904929
DOI: 10.1007/s11701-024-02028-z -
European Journal of Obstetrics,... Nov 2023Perineal injury occurs in 85% of cases during vaginal childbirth. This study aimed to synthesize qualitative data on women's perceptions of perineal trauma during... (Review)
Review
OBJECTIVES
Perineal injury occurs in 85% of cases during vaginal childbirth. This study aimed to synthesize qualitative data on women's perceptions of perineal trauma during vaginal childbirth.
STUDY DESIGN
Thematic synthesis was applied utilizing a structured three-step framework. First, line-by-line coding strategy was applied to the included studies. Secondly, related codes were grouped together to develop descriptive themes to emphasize what matters most for women suffering from childbirth perineal trauma. Thirdly, analytical themes were developed. The quality of the included studies was high based on the assessment using the Critical Appraisal Skills Programme tool.
RESULTS
Ten eligible studies were included in the meta-synthesis. Twenty-three codes encompassing multiple aspects of childbirth trauma from women's perspective were organised into a set of eight descriptive themes: psychosocial effects, communication, recovery, pain, support, knowledge of childbirth perineal trauma, sexuality, and prioritization.
CONCLUSIONS
Among the descriptive themes, psychosocial effects, communication, and recovery exhibited the highest prevalence. The findings of this meta-synthesis may serve as a reporting guideline for future studies investigating the consequences of childbirth perineal trauma, ensuring that women's priorities are accurately reflected in reported outcomes.
Topics: Pregnancy; Female; Humans; Parturition; Delivery, Obstetric; Birth Injuries; Qualitative Research; Perineum; Outcome Assessment, Health Care
PubMed: 37734138
DOI: 10.1016/j.ejogrb.2023.09.010 -
Quantitative Imaging in Medicine and... Dec 2023Induction of labor (IOL) is a common obstetric approach to start or encourage uterine contractions to achieve a vaginal birth. It is recommended when continuing the...
BACKGROUND
Induction of labor (IOL) is a common obstetric approach to start or encourage uterine contractions to achieve a vaginal birth. It is recommended when continuing the pregnancy may be more dangerous for the mother or baby. Different ultrasonographic measures, such as cervical length, have been investigated as possible predictors of the outcomes of IOL. This meta-analysis aimed to assess the accuracy of ultrasound measurements in anticipating successful IOL.
METHODS
The study conducted a thorough search on three databases (PubMed, Scopus, and Web of Science) until 04 March 2023, to find clinical studies published in English that reported different sonographic cervical measures and their ability to predict IOL outcomes. The chosen studies were stratified based on the type of indicator reported, and a meta-analysis was conducted to determine the best indicator for both successful and failed induction. The risk of bias and concerns about the applicability of the included studies was evaluated using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) method.
RESULTS
This study analyzed 57 studies with 9,338 patients. Cervical length is moderately effective in predicting successful IOL, with pooled sensitivity (SN) and specificity (SP) of 0.67 and 0.70, respectively. However, cervical length had a pooled SN and SP of 0.70 and 0.61 for predicting failed IOL. The posterior cervical angle was found to have a higher pooled SN and SP of 0.79 and 0.73 for predicting successful IOL. Fetal head-perineum distance demonstrated moderate accuracy with a pooled SN, SP, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and area under the curve of 0.58, 0.66, 1.95, 0.36, 5.33, and 0.9992, respectively, for predicting successful IOL.
CONCLUSIONS
Fetal head-perineum distance was the most effective predictor for successful IOL compared to cervical length, which only had a moderate predictive ability. Shortening of cervical length was not a useful indicator for successful IOL. On the other hand, the posterior cervical angle was the most reliable factor for predicting failed induction. The study's findings can aid in developing more effective management strategies for IOL.
PubMed: 38106269
DOI: 10.21037/qims-23-507 -
Prostate Cancer and Prostatic Diseases Jun 2024Magnetic resonance imaging (MRI) has deeply altered the prostate biopsy strategy to detect prostate cancer. However, it is still debatable whether the detection rate... (Meta-Analysis)
Meta-Analysis Comparative Study Review
PURPOSE
Magnetic resonance imaging (MRI) has deeply altered the prostate biopsy strategy to detect prostate cancer. However, it is still debatable whether the detection rate differs between transrectal (TR) and transperineal (TP) MRI-targeted biopsy (MRI-TB). To compare the effectiveness of these two methods for detecting both overall prostate cancer (PCa) and clinically significant PCa (csPCa), We performed a review and meta-analysis.
METHODS
Until January 2023, we conducted a thorough search of Cochrane, Embase, Ovid, and PubMed. In total, 1482 references were identified, and 15 records were finally included. For PCa and csPCa discovered by TP and TR MRI-TB, we combined the relative sensitivity (RR) with 95% confidence intervals (CI). The RR between the TP and TR routes was established.
RESULTS
Our study included 8826 patients in total and revealed that TP MRI-TB detected more PCa (RR 1.25 [95% CI 1.12, 1.39], p < 0.0001). In patients who underwent TP MRI-TB and TR MRI-TB at the same time or separately, TP MRI-TB had a greater detection rate of csPCa in per-patient analysis (one cohort (RR 1.33 [95% CI 1.09, 1.63], p = 0.005); two cohorts (RR 1.37 [95% CI 1.16, 1.61], p = 0.0002)). However, the detection rate of csPCa between the TP route and the TR route was comparable in per-lesion analysis (RR 0.91 [95% CI 0.76, 1.08], p = 0.28). Additionally, in the prostate's anterior region, we found that TP MRI-TB detected more csPCa (per-lesion (RR 1.52 [95% CI 1.04, 2.23], p = 0.03); per-patient (RR 2.55 [95% CI 1.56, 4.16], p = 0.0002)).
CONCLUSION
According to this comprehensive study, TP MRI-TB is more effective than TR MRI-TB at detecting PCa and csPCa. Significant results persisted for detecting csPCa located in the anterior zone. The results need to be taken carefully notwithstanding the heterogeneity among the included studies.
Topics: Humans; Male; Prostatic Neoplasms; Image-Guided Biopsy; Magnetic Resonance Imaging; Perineum; Rectum
PubMed: 37783837
DOI: 10.1038/s41391-023-00729-4 -
Techniques in Coloproctology Dec 2023To mitigate pelvic wound issues following perineal excision of rectal or anal cancer, a number of techniques have been suggested as an alternative to primary closure.... (Meta-Analysis)
Meta-Analysis
BACKGROUND
To mitigate pelvic wound issues following perineal excision of rectal or anal cancer, a number of techniques have been suggested as an alternative to primary closure. These methods include the use of a biological/dual mesh, omentoplasty, muscle flap, and/or pelvic peritoneum closure. The aim of this network analysis was to compare all the available surgical techniques used in the attempt to mitigate issues associated with an empty pelvis.
METHODS
An electronic systematic search using MEDLINE databases (PubMed), EMBASE, and Web of Science was performed (Last date of research was March 15th, 2023). Studies comparing at least two of the aforementioned surgical techniques for perineal wound reconstruction during abdominoperineal resection, pelvic exenteration, or extra levator abdominoperineal excision were included. The incidence of primary healing, complication, and/or reintervention for perineal wound were evaluated. In addition, the overall incidence of perineal hernia was assessed.
RESULTS
Forty-five observational studies and five randomized controlled trials were eligible for inclusion reporting on 146,398 patients. All the surgical techniques had a comparable risk ratio (RR) in terms of primary outcomes. The pooled network analysis showed a lower RR for perineal wound infection when comparing primary closure (RR 0.53; Crl 0.33, 0.89) to muscle flap. The perineal wound dehiscence RR was lower when comparing both omentoplasty (RR 0.59; Crl 0.38, 0.95) and primary closure (RR 0.58; Crl 0.46, 0.77) to muscle flap.
CONCLUSIONS
Surgical options for perineal wound closure have evolved significantly over the last few decades. There remains no clear consensus on the "best" option, and tailoring to the individual remains a critical factor.
Topics: Humans; Network Meta-Analysis; Perineum; Plastic Surgery Procedures; Postoperative Complications; Surgical Flaps
PubMed: 37843643
DOI: 10.1007/s10151-023-02868-1 -
Wound Repair and Regeneration :... 2024Keloid is the maximum expression of pathological fibroproliferative skin wound healing, whose pathophysiology is not yet fully understood. Its occurrence in the perineum... (Review)
Review
Keloid is the maximum expression of pathological fibroproliferative skin wound healing, whose pathophysiology is not yet fully understood. Its occurrence in the perineum and genitalia is uncommon. A systematic review was carried out regarding the occurrence and treatment of keloids on the penis. An illustrative case was also reported. The review used the PRISMA checklist and was registered in PROSPERO. The entire literature period up to April 2023 was searched in the EMBASE/Elsevier, Cochrane, Scopus, Medline, BVS, SciELO, and Lilacs databases. The inclusion criteria embraced primary studies, clinical trials, prospective or retrospective cohorts, case series, case-control studies and case reports. Three hundred and sixty-one studies were found and 12 of them were included, consisting of 9 case reports and 3 case series. The most common triggering factor for keloid formation was circumcision, in 11 of the cases, of which more than half occurred in prepubescent children. Several therapies, associated or isolated, were used to treat the cases. Only one of the reported patients had scar recurrence after surgical treatment. Studies with better scientific evidence are needed to understand the involvement of keloids in male genitalia. However, keloid formation in this topography is rare, making it difficult to carry out more elaborate studies.
Topics: Child; Humans; Male; Keloid; Retrospective Studies; Prospective Studies; Wound Healing; Genitalia, Male
PubMed: 38351501
DOI: 10.1111/wrr.13157 -
Archives of Gynecology and Obstetrics Aug 2023Most women suffer from perineal trauma during childbirth, whether it is natural tears or episiotomy. (Meta-Analysis)
Meta-Analysis
BACKGROUND
Most women suffer from perineal trauma during childbirth, whether it is natural tears or episiotomy.
OBJECTIVES
To perform a systematic review and network meta-analysis investigating the effectiveness of different PFMT relevant strategies in the prevention of perineal trauma.
SEARCH STRATEGY
PubMed, Embase, the Cochrane Library, CINAHL, CNKI, CBM, WANFANG DATABASE, and ClinicalTrials.gov were searched for citations published in any language from inception to 1 July 2021.
SELECTION CRITERIA
Randomized controlled trials (RCTs) of PFMT relevant prevention strategies for preventing perineal trauma during childbirth.
DATA COLLECTION AND ANALYSIS
Data were independently extracted by two reviewers. Relative treatment effects were estimated using network meta-analysis (NMA).
MAIN RESULTS
Of 12 632 citations searched, 21 RCTs were included. Comparing with usual care, "PFMT combine with perineal massage" and PFMT alone showed more superiority in intact perineum (RR = 5.37, 95% CI: 3.79 to 7.60, moderate certainty; RR = 2.58, 95% CI 1.34-4.97, moderate certainty, respectively), episiotomy (RR = 0.26, 95% CI 0.14-0.49, very low certainty; RR = 0.63, 95% CI 0.45-0.90, very low certainty, respectively), and OASIS (RR = 0.35, 95% CI 0.16-0.78, moderate certainty; RR = 0.49, 95% CI 0.28-0.85, high certainty, respectively). "PFMT combine with perineal massage" showed superiority in reducing perineal tear (RR = 0.41, 95% CI 0.20-0.85, moderate certainty).
CONCLUSIONS
In view of the results, antenatal "PFMT combine with perineal massage" and PFMT were effective strategies for the prevention of perineal trauma.
Topics: Female; Humans; Pregnancy; Delivery, Obstetric; Episiotomy; Lacerations; Network Meta-Analysis; Parturition
PubMed: 36107230
DOI: 10.1007/s00404-022-06769-w