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The Cochrane Database of Systematic... May 2011Despite changes in technique, morbidity after surgery for vulvar cancer is high and mainly related to the groin dissection. Primary radiotherapy to the groin is expected... (Comparative Study)
Comparative Study Review
BACKGROUND
Despite changes in technique, morbidity after surgery for vulvar cancer is high and mainly related to the groin dissection. Primary radiotherapy to the groin is expected to result in lower morbidity. However, studies on the efficacy of primary radiotherapy to the groin in terms of groin recurrences and survival show conflicting results.
OBJECTIVES
To determine whether the effectiveness and safety of primary radiotherapy to the inguinofemoral lymph nodes in early vulvar cancer is comparable with surgery.
SEARCH STRATEGY
We searched The Cochrane Gynaecological Cancer Group Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE from 1966 to July 2010.
SELECTION CRITERIA
We selected randomised clinical trials (RCTs) comparing inguinofemoral lymph node dissection and primary radiotherapy of the inguinofemoral lymph nodes for patients with early squamous cell cancer of the vulva.
DATA COLLECTION AND ANALYSIS
Two reviewers independently assessed study quality and extracted results. Primary outcome measures were the incidence of groin recurrences, patient survival and morbidity.
MAIN RESULTS
No new RCTs were identified by the updated search. Out of twelve identified papers only one met the selection criteria. From this one small RCT of 52 women, there was a trend towards increased groin recurrence rates (relative risk (RR) 10.21, 95% confidence interval (CI) 0.59 to 175.78), lower disease-specific survival rates (RR 3.70, 95% CI 0.87 to 15.80), less lymphoedema (RR 0.06, 95% CI 0.00 to 1.03) and fewer life-threatening cardiovascular complications (RR 0.08, 95% CI 0.00 to 1.45) in the radiotherapy group. Primary surgery was associated with a longer hospital stay than primary groin irradiation (RR 0.28, 95% CI 0.13 to 0.58).
AUTHORS' CONCLUSIONS
Primary radiotherapy to the groin results in less morbidity but may be associated with a higher risk of groin recurrence and decreased survival when compared with surgery. Due to the small numbers in this trial and criticisms regarding the depth of radiotherapy applied, corroboration of these findings by larger RCTs using a standardised radiotherapy method, is desirable. However, until better evidence is available, surgery should be considered the first choice treatment for the groin nodes in women with vulvar cancer. Individual patients not physically able to withstand surgery may be treated with primary radiotherapy.
Topics: Carcinoma, Squamous Cell; Female; Humans; Inguinal Canal; Lymph Nodes; Neoplasm Recurrence, Local; Neoplasm Staging; Randomized Controlled Trials as Topic; Vulvar Neoplasms
PubMed: 21563133
DOI: 10.1002/14651858.CD002224.pub2 -
Medicine Dec 2022Granular cell tumor (GCT) of the vulva is an exceptionally rare female genital tract tumor. The majority of these are benign and there are no standardized surgical...
RATIONALE
Granular cell tumor (GCT) of the vulva is an exceptionally rare female genital tract tumor. The majority of these are benign and there are no standardized surgical techniques for the special site to reduce tension of the wound.
PATIENT CONCERNS
A 47-years-old Chinese woman experienced a nodule on her right vulva with itch sometimes in late 2018.
DIAGNOSES
Magnetic resonance imaging showed a high possibility of vulvar cancer. While Chest X-ray, abdominal sonography, and cystoscopy examination were unremarkable.
INTERVENTIONS
The patient underwent local complete resection of vulvar tumor under general anesthesia on March 24, 2022. The resection scope was approximately 4 cm × 3 cm × 3 cm. Due to the large surgical incision, Z-plasty was performed to achieve the primary closure for decreasing wound tension and improving aesthetic reduction.
OUTCOMES
The final pathological diagnosis was benign GCT of the vulva and surgical margins were uninvolved. At 8 months follow-up, no new lesions were detected.
LESSONS
Surgery with negative resection margins is the mainstay for benign GCT of the vulva, while Z-plasty is appropriate for decreasing the tension of the wound and improving aesthetic reduction.
Topics: Female; Humans; Middle Aged; Granular Cell Tumor; Plastic Surgery Procedures; Pruritus; Vulva; Vulvar Neoplasms; Vulvectomy
PubMed: 36595970
DOI: 10.1097/MD.0000000000032568 -
The Cochrane Database of Systematic... Jan 2011Vulval intraepithelial neoplasia (VIN) is a pre-malignant condition of the vulval skin. This uncommon chronic skin condition of the vulva is associated with a high risk... (Review)
Review
BACKGROUND
Vulval intraepithelial neoplasia (VIN) is a pre-malignant condition of the vulval skin. This uncommon chronic skin condition of the vulva is associated with a high risk of recurrence and the potential to progress to vulval cancer. The condition is complicated by its' multicentric and multifocal nature. The incidence of this condition appears to be rising particularly in the younger age group.There is a lack of consensus on the optimal surgical treatment method. However, the rationale for surgical treatment of VIN has been to treat symptoms and exclude underlying malignancy with the continued aim of preservation of vulval anatomy and function. Repeated treatments affect local cosmesis and cause psychosexual morbidity thus impacting on the patients' quality of life.
OBJECTIVES
To evaluate the effectiveness and safety of surgical interventions for high grade VIN.
SEARCH STRATEGY
We searched the Cochrane Central Register of Controlled Trials (CENTRAL), Issue 3, 2010, Cochrane Gynaecological Cancer Group Trials Register, MEDLINE and EMBASE up to September 2010. We also searched registers of clinical trials, abstracts of scientific meetings, reference lists of included studies and contacted experts in the field.
SELECTION CRITERIA
Randomised controlled trials (RCTs) that compared surgical interventions, in adult women diagnosed with high grade vulval intraepithelial neoplasia.
DATA COLLECTION AND ANALYSIS
Two review authors independently abstracted data and assessed risk of bias.
MAIN RESULTS
We found only one RCT which included 30 women that met our inclusion criteria and this trial reported data on carbon dioxide laser (CO(2) laser) versus ultrasonic surgical aspiration (USA).There was no statistically significant difference in the risk of disease recurrence after one year follow-up, pain, presence of scarring, dysuria or burning, adhesions, infection, abnormal discharge and eschar between women who received CO(2) laser and those who received USA. The trial lacked statistical power due to the small number of women in each group and the low number of observed events, but was at low risk of bias.
AUTHORS' CONCLUSIONS
The included trial lacked statistical power due to the small number of women in each group and the low number of observed events. Therefore in the absence of reliable evidence regarding the effectiveness and safety of the two surgical techniques for the management of vulval intraepithelial neoplasia precludes any definitive guidance or recommendations for clinical practice.
Topics: Adult; Carcinoma in Situ; Female; Humans; Lasers, Gas; Precancerous Conditions; Randomized Controlled Trials as Topic; Suction; Ultrasonic Therapy; Vulvar Neoplasms
PubMed: 21249698
DOI: 10.1002/14651858.CD007928.pub2 -
Plastic and Reconstructive Surgery.... Jan 2021Tissue expansion is a versatile reconstructive technique providing well-vascularized local tissue. The current literature focuses largely on tissue expansion for breast...
BACKGROUND
Tissue expansion is a versatile reconstructive technique providing well-vascularized local tissue. The current literature focuses largely on tissue expansion for breast reconstruction and in the context of burn and pediatric skin/soft tissue replacement; however, less traditional applications are also prevalent. The aim of this study was to systematically review the utilization of tissue expansion in such less well-characterized circumstances.
METHODS
The authors conducted a systematic review of all publications describing non-breast applications of tissue expansion. Variables regarding expander specifications, expansion process, and complications were collected and further analyzed.
RESULTS
A total of 565 publications were identified. Of these, 166 publications described tissue expansion for "less traditional" indications, which fell into 5 categories: ear reconstruction, cranioplasty, abdominal wall reconstruction, orthopedic procedures, and genital (penile/scrotal and vaginal/vulva) reconstruction. While lower extremity expansion is known to have high complication rates, tissue expander failure, infection, and exposure rates were in fact highest for penile/scrotal (failure: 18.5%; infection: 15.5%; exposure: 12.5%) and vaginal/vulva (failure: 20.6%; infection: 10.3%; exposure: 6.9%) reconstruction.
CONCLUSIONS
Tissue expansion enables index operations by providing additional skin before definitive reconstruction. Tissue expanders are a valuable option along the reconstructive ladder because they obviate the need for free tissue transfer. Although tissue expansion comes with inherent risk, aggregate outcome failures of the final reconstruction are similar to published rates of complications without pre-expansion. Thus, although tissue expansion requires a staged approach, it remains a valuable option in facilitating a variety of reconstructive procedures.
PubMed: 33564595
DOI: 10.1097/GOX.0000000000003378 -
International Journal of Gynaecology... May 2015Clitoral reconstruction is a new surgical technique for women who have undergone female genital mutilation/cutting (FGM/C). (Review)
Review
BACKGROUND
Clitoral reconstruction is a new surgical technique for women who have undergone female genital mutilation/cutting (FGM/C).
OBJECTIVES
To review evidence on the safety and efficacy of clitoral reconstruction.
SEARCH STRATEGY
PubMed and Cochrane databases were searched for articles published in any language from database inception until May 2014. Search terms related to FGM/C and clitoral reconstruction were used in various combinations.
SELECTION CRITERIA
Studies of any design that reported on safety or clinical outcomes (e.g. appearance, pain, sexual response, or patient satisfaction) associated with clitoral reconstruction after FGM/C were included.
DATA COLLECTION AND ANALYSIS
Evidence was summarized and systematically assessed via a standard data abstraction form.
MAIN RESULTS
Four of 269 identified articles were included. They were fair to poor in quality. Summary measures could not be computed owing to heterogeneity. The studies reported on immediate surgical complications, clitoral appearance, dyspareunia or chronic pain, and clitoral function postoperatively via non-standardized scales.
CONCLUSIONS
Women who request clitoral reconstruction should be informed about the scarcity of evidence available. Additional research is needed on the safety and efficacy of the procedure to identify both long-term outcomes and which women might benefit.
Topics: Circumcision, Female; Clitoris; Female; Gynecologic Surgical Procedures; Humans
PubMed: 25638712
DOI: 10.1016/j.ijgo.2014.11.008 -
Journal of Ethnopharmacology Feb 2024The genus Alchemilla L. (lady's mantle) comprises 1000 species, of which more than 300 have been characterized from Europe. Notably, as folk medicines, Alchemilla... (Review)
Review
ETHNOPHARMACOLOGICAL RELEVANCE
The genus Alchemilla L. (lady's mantle) comprises 1000 species, of which more than 300 have been characterized from Europe. Notably, as folk medicines, Alchemilla species have long been prescribed for the treatment of dysmenorrhea, pruritus vulvae, menopausal complaints, and related diseases in women. This review summarizes the traditional uses, highlights promising plant species, and focuses on phytochemical and biological studies to highlight future areas of research.
AIM OF THE REVIEW
This literature review aims to provide a comprehensive overview of Alchemilla species, covering their botany, traditional uses, phytochemistry, and biological and pharmacological activities, and to summarize the current research status to better understand the application value of Alchemilla plants in modern phytotherapy.
MATERIALS AND METHODS
The search strategy utilized the major thematic platforms Reaxys, Web of Science, Google Scholar, Scopus, ScienceDirect, PubMed, the USDA Plant Database and Kew Science (Royal Botanic Gardens) and was performed with the term Alchemilla. These platforms were systematically searched for articles published from 1960 to 2023.
RESULTS AND DISCUSSION
Alchemilla species, as members of the Rosaceae family, produce tannins, phenolic acids, flavonoids, anthocyanins, coumarins, triterpenes and violet compounds. Effort has been made with this comprehensive review of Alchemilla plants to highlight the recent developments and milestones achieved in modern phytochemistry and phytotherapy, underlaying a broad spectrum of the activities of these plants, such as antioxidant, anti-inflammatory, neuroprotective, antimicrobial, antiobesity, cardiovascular, anticancer, and wound healing effects.
CONCLUSIONS
An increasing number of studies on the plants in the Alchemilla genus have provided data about the main constituents and their importance in modern medicine. Both in vitro and in vivo studies have indicated that Alchemilla plants possess an extensive spectrum of biological activities. Regardless of the remarkable medical potential of Alchemilla extracts, clinical studies are limited and need to be performed to produce safer and less expensive plant-based drugs.
Topics: Female; Humans; Ethnopharmacology; Plants, Medicinal; Alchemilla; Rosaceae; Anthocyanins; Phytotherapy; Plant Extracts; Phytochemicals
PubMed: 37981119
DOI: 10.1016/j.jep.2023.117439 -
Journal of the American Academy of... May 2023
Topics: Female; Humans; Vulva; Vulvar Lichen Sclerosus; Laser Therapy; Vulvar Neoplasms; Carcinoma in Situ; Precancerous Conditions; Lichen Sclerosus et Atrophicus
PubMed: 36639033
DOI: 10.1016/j.jaad.2023.01.003 -
The Cochrane Database of Systematic... Jun 2019This is an updated version of the original Cochrane Review published in Issue 10, 2013.Extramammary Paget's disease is a rare form of superficial skin cancer. The most...
BACKGROUND
This is an updated version of the original Cochrane Review published in Issue 10, 2013.Extramammary Paget's disease is a rare form of superficial skin cancer. The most common site of involvement is the vulva. It is seen mainly in postmenopausal white women. Paget's disease of the vulva often spreads in an occult fashion, with margins extending beyond the apparent edges of the lesion. There is a range of interventions from surgical to non-invasive techniques or treatments. The challenges of interventions are to remove or treat disease that may not be visible, without overtreatment and with minimisation of morbidity from radical surgery. There is little consensus regarding treatment. Surgery, by default, is the most common treatment, but it is challenging to excise the disease adequately, and recurrence is common, leading to repeated operations, and destruction of anatomy. Alternative treatments of photodynamic therapy, laser therapy, radiotherapy, topical treatments or even chemotherapy have been mooted, and it is important to evaluate the available evidence. It is essential to assess whether newer cell-specific treatments, such as photodynamic therapy and imiquimod, can reduce the need for radical surgery.
OBJECTIVES
To evaluate the benefits and harms of different treatment modalities for the management of Paget's disease of the vulva.
SEARCH METHODS
We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (via Ovid) and Embase (via Ovid) up to 8 May 2018. We also searched registers of clinical trials, abstracts of scientific meetings and reference lists of review articles.
SELECTION CRITERIA
We searched for randomised controlled trials (RCTs) and well-designed non-randomised studies that compared different interventions in women with Paget's disease of the vulva, DATA COLLECTION AND ANALYSIS: Two review authors independently assessed whether potentially relevant studies met the inclusion criteria. We found no trials and, therefore, analysed no data.
MAIN RESULTS
The search for the original version of the review identified 635 unique references. We found 31 references (which reported on 30 studies) in full text after inspection of titles and abstracts, but we excluded them all as they did not meet the inclusion criteria. However, we have included a comprehensive narrative account of studies where we identified an analysis of more than 10 women, as this forms the only evidence base in this rare disease. Surgery continues to be the mainstay of treatment in the current literature, with other treatments limited to case reports or treatment of inoperable or recurrent disease.This update between September 2013 and May 2018 identified 35 new studies. None of these met the inclusion criteria. There was only one prospective study of 5% imiquimod in recurrent Paget's disease of the vulva, which although of good quality only included eight women.
AUTHORS' CONCLUSIONS
Since the last version of the review was published there are many more cases in the literature reporting a clinical response to 5% imiquimod cream. There is one prospective study of eight women treated with 5% imiquimod for recurrent Paget's disease of the vulva, and one prospective trial of 20 women was due to be reported. This increasing evidence for the safety and efficacy of 5% imiquimod will be helpful for women and clinicians alike. Ideally, a multicentre RCT of reasonable size is needed, but ongoing publications of high-quality non-randomised prospective studies will enhance the current available literature.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Antineoplastic Agents; Female; Humans; Imiquimod; Laser Therapy; Middle Aged; Paget Disease, Extramammary; Photochemotherapy; Randomized Controlled Trials as Topic; Vulvar Neoplasms
PubMed: 31167037
DOI: 10.1002/14651858.CD009245.pub3 -
Experimental and Therapeutic Medicine Oct 2020Vaginitis, also known as vulvovaginitis, is an inflammation of the vagina and vulva and a common disease in females. It is thought to be caused by vaginal dysbiosis and...
Vaginitis, also known as vulvovaginitis, is an inflammation of the vagina and vulva and a common disease in females. It is thought to be caused by vaginal dysbiosis and improved by probiotics. Bacterial vaginosis (BV) and vulvovaginal candidiasis (VVC) are the major types of vaginal infections. The present systematic review and meta-analysis aimed to clarify the efficacy of probiotics in the treatment of common vaginal infections in non-pregnant females. Literature on randomized controlled trials and two-armed prospective studies on any intervention with probiotics published until December 24th, 2018 was searched in the PubMed, Cochrane and EMBASE databases. The outcomes of interest were recurrence rate, cure rate, remission rate and normal vaginal flora restoration. Finally, a total of 30 studies on bacterial vaginosis (BV) and/or VVC were included and stratified into 3 study types based on treatment design as follows: Type I, antibiotic/probiotics vs. antibiotics/antifungals (22 studies); Type II, probiotics vs. placebo (5 studies); Type III, probiotics vs. antibiotics (3 studies). The type I studies comprised 1,788 non-pregnant females and had the highest inter-study comparability in post-treatment follow-up design and meta-analysis outcome data. Probiotics interventions were significantly associated with a lower recurrence rate of vaginitis [pooled odds ratio (OR)=0.27, 95% CI: 0.18-0.41, P<0.001] and higher cure/remission rate (pooled OR=2.28, 95% CI: 1.20-4.32, P=0.011). However, a significant increase in normal vaginal flora after probiotic treatment was observed only in BV (pooled OR=4.55, 95% CI: 1.44-14.35, P=0.01). In addition, supportive but heterogeneous results were obtained from the 6-month follow-up data of Type-I studies, different infection types and supplementary analysis of Type-II studies. In conclusion, probiotics have a significant short-term effect in the treatment of common vaginal infections in non-pregnant females. In order to evaluate the long-term effects of probiotics in common vaginal infections, it is worthwhile to perform higher-quality clinical trials in the future.
PubMed: 32855726
DOI: 10.3892/etm.2020.9090 -
Journal of Infection in Developing... Aug 2022Vulvovaginal candidiasis (VVC) is a yeast infection of the vulva, which is caused by Candida species and affects women worldwide. Pregnant women are more vulnerable to... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Vulvovaginal candidiasis (VVC) is a yeast infection of the vulva, which is caused by Candida species and affects women worldwide. Pregnant women are more vulnerable to VVC due to certain risks. Moreover, their offspring are also exposed to the risk of preterm birth. In this context, ascertaining the burden of VVC is of paramount importance and this meta-analysis was conducted to estimate the occurrence of VVC among pregnant women in Africa.
METHODOLOGY
Database search was carried out through PubMed, Scopus, Science-Direct, and Google Scholar from the date of inception until December 2020. All the studies on the prevalence of VVC among African pregnant women were included in the analysis. The pooled prevalence was estimated based on the Random-effect model DerSimonian-Laird approach with Freeman- Tukey double arcsine transformed proportion. Heterogeneity was assessed using I2 test and subsequently explored using subgroup and meta-regression analysis.
RESULTS
A total of Sixteen records having a sample size 4,185 were included in this study. The overall prevalence of VVC was pooled at 29.2% (CI 95%: 23.4 - 33.0). Subgroup analysis revealed a higher prevalence in Eastern Africa, followed by Western Africa and North Africa (35%, 28%, and 15% respectively). Moderator analysis indicated that the studies that used advanced methods of detection had a higher prevalence (p = 0.048). In addition, the large sample size was associated with higher prevalence (p ≤ 0.001). No other moderators were found to be statistically significant.
CONCLUSIONS
The overall prevalence of VVC among African pregnant women is comparable to other studies worldwide. However, appropriate identification techniques and larger sample size could likely be associated with an increased prevalence. Our findings necessitate the need for further investigations to determine the geographical distribution of VVC across African regions.
Topics: Africa; Candidiasis, Vulvovaginal; Female; Humans; Infant, Newborn; Pregnancy; Pregnant Women; Premature Birth; Prevalence
PubMed: 36099366
DOI: 10.3855/jidc.15536