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Oncology Research and Treatment 2018Uterine leiomyosarcoma (uLMS) is a rare entity among malignant gynecologic tumors with a very unfavorable prognosis and the highest prevalence in the pre- and... (Review)
Review
Uterine leiomyosarcoma (uLMS) is a rare entity among malignant gynecologic tumors with a very unfavorable prognosis and the highest prevalence in the pre- and peri-menopause. Only early-stage tumors have an acceptable prognosis, provided the patient has been treated without injuring the uterus. uLMS is often diagnosed accidentally and the correct diagnosis ishampered by equivocal features similar to the far more frequent benign uterine fibroids. Surgery is the basis of therapy, and it should be done in order to remove the uterus intact. As vaginal, abdominal, and endoscopic surgery - possibly including morcellation - are the methods of choice for the treatment of uterine fibroids, pre-operatively undiagnosed leiomyosarcoma detected by pathologic examination will have a worsened prognosis. Systemic treatment and radiotherapy are of no proven value in the adjuvant setting. Thus, there is strong need for a reliable pre-operative risk score for leiomyosarcoma in order to justify diagnostic means beyond clinical routine and to choose the correct surgical pathway. The clinical problems in the diagnosis of leiomyosarcoma and treatment are exemplified by a case report of a 30-year-old childless patient. Diagnostic tools as well as treatment options in adjuvant and palliative situations are reviewed.
Topics: Adult; Antineoplastic Combined Chemotherapy Protocols; Biopsy; Chemoradiotherapy, Adjuvant; Diagnosis, Differential; Female; Humans; Hysterectomy; Leiomyoma; Leiomyosarcoma; Magnetic Resonance Imaging; Neoplasm Recurrence, Local; Prognosis; Risk Assessment; Ultrasonography; Uterine Neoplasms; Uterus
PubMed: 30321869
DOI: 10.1159/000494299 -
Gynecology and Minimally Invasive... 2021Retained products of conception (RPOC) can occur after early or mid-trimester pregnancy termination and also following vaginal or cesarean delivery. It is frequently... (Review)
Review
Retained products of conception (RPOC) can occur after early or mid-trimester pregnancy termination and also following vaginal or cesarean delivery. It is frequently associated with continuous vaginal bleeding, pelvic pain, and infection. Late complications include intrauterine adhesions formation and infertility. Conventionally, the management of RPOC has been with blind dilation and suction curettage (D and C); however, hysteroscopic resection of RPOC is a safe and efficient alternative. In this review, we analyze the current available evidence regarding the use of hysteroscopic surgery for the treatment of RPOC comparing outcomes and complications of both traditional curettage and hysteroscopic technique. Data search has been conducted using the following databases MEDLINE, EMBASE, Web of Sciences, Scopus, Clinical Trial. Gov., OVID, and Cochrane Library interrogate all articles related to hysteroscopy and the preserved product of conception, updated through September 2020.
PubMed: 34909376
DOI: 10.4103/GMIT.GMIT_125_20 -
The Canadian Journal of Urology Aug 2021INTRODUCTION Transurethral resection of the prostate (TURP) was considered the "gold standard" surgical treatment for medication-refractory benign prostatic hyperplasia... (Review)
Review
UNLABELLED
INTRODUCTION Transurethral resection of the prostate (TURP) was considered the "gold standard" surgical treatment for medication-refractory benign prostatic hyperplasia (BPH) for decades. With the desire to reduce hospital stay, complications, and cost, less invasive procedures gained usage in the 1990's. With the advent of a soft tissue morcellator, holmium laser enucleation of the prostate (HoLEP) was introduced as an efficacious alternative to TURP and due to its advantageous side effect profile compared to TURP, has grown in popularity ever since. HoLEP has become a size-independent guideline endorsed procedure of choice for the surgical treatment of BPH.
MATERIALS AND METHODS
We provide a review on the evolution of HoLEP as a gold standard compared to the historical reference procedures for BPH, and provide a review of emerging laser technologies.
RESULTS
A growing body of literature has shown HoLEP to be a safe and efficient procedure for the treatment of BPH for all prostate sizes. Long term studies have proven the durability of HoLEP, as a first line surgical therapy for BPH.
CONCLUSIONS
HoLEP is a proven modality for the surgical treatment of BPH. It can be performed on patients with high risk for postoperative bleeding, or after previous prostate reducing procedures. HoLEP is the only procedure that is AUA guideline-endorsed for all prostate sizes for the surgical treatment of BPH. Given these considerations, HoLEP has become the new gold-standard for the surgical treatment of BPH.
Topics: Humans; Laser Therapy; Lasers, Solid-State; Male; Prostate; Prostatic Hyperplasia; Transurethral Resection of Prostate; Treatment Outcome
PubMed: 34453422
DOI: No ID Found -
The Canadian Journal of Urology Aug 2019Lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) is one of the most common diseases affecting the aging man, with almost 80% of men... (Review)
Review
INTRODUCTION
Lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) is one of the most common diseases affecting the aging man, with almost 80% of men greater than 70 affected. Historically, transurethral resection of the prostate (TURP) has been considered the historical gold standard in the treatment of LUTS due to BPH for many years, contemporary literature indicates that holmium laser enucleation of the prostate (HoLEP) has replaced TURP and open simple prostatectomy as the size independent surgical gold standard for BPH treatment.
MATERIALS AND METHODS
In this review, we discuss the current techniques utilized, outcomes and safety, as well as the long term durability of results. Adverse events associated with the HoLEP procedure, both enucleation and morcellation, are covered as well.
RESULTS
HoLEP has a robust body of literature supporting the technique, which demonstrates its ability to surpass other surgical BPH procedures, including TURP and open simple prostatectomy. Additionally, there is long term durability of both subjective and objective outcomes greater than 10 years associated with this procedure. One randomized trial showed specific postoperative outcome measures that were superior to TURP at 7 years of follow up, including Qmax (4.36 mL/s improvement), erectile function (2.39 points improvement on the IIEF erectile function section), and weight of prostate removed (15.7 grams greater), while other studies have shown greater reduction in postoperative PSA, lower detrusor pressure at Qmax, and more.
CONCLUSIONS
Overall, HoLEP has proven to be an extremely durable and effective treatment for patients suffering from LUTS due to BPH. Both the Europeans and AUA guidelines on the surgical treatment of BPH recommend HoLEP as a size-independent treatment option for those men with moderate to severe symptoms. HoLEP is an excellent option for many patients who may not be good candidates for other procedures based on prostate size, age, or bleeding risk.
Topics: Holmium; Humans; Laser Therapy; Lasers, Solid-State; Male; Prostatic Hyperplasia; Prostatism; Treatment Outcome
PubMed: 31481144
DOI: No ID Found -
JSLS : Journal of the Society of... 2015Transvaginal uterine morcellation has been described in the literature for more than a century. Despite an extensive body of literature documenting its safety and...
BACKGROUND AND OBJECTIVES
Transvaginal uterine morcellation has been described in the literature for more than a century. Despite an extensive body of literature documenting its safety and feasibility, concerns about morcellating occult malignant entities have raised questions regarding this technique. In this study, we looked at a single teaching institution's experience with transvaginal morcellation for leiomyomatous uteri. In addition, we reviewed the published literature for outcomes associated with transvaginal morcellation techniques.
METHODS
This study was a retrospective case series. Charts of women who underwent total laparoscopic hysterectomy, robot-assisted laparoscopic hysterectomy, and laparoscopic-assisted vaginal hysterectomy for leiomyoma from July 1, 2011, through December 31, 2013, were reviewed. Cases were included if transvaginal morcellation was performed. Morcellation was performed by bringing the uterus into the vagina and by performing a wedge resection technique to reduce the volume of the specimen. Baseline demographics and intra- and postoperative outcomes were abstracted from the charts. A PubMed search from January 1, 1970 to October 31, 2014 was performed to review the literature regarding transvaginal morcellation.
RESULTS
Sixty-four women who underwent laparoscopy for leiomyomatous uteri with transvaginal morcellation were identified from July 1, 2011 through December 31, 2013. Mean operative time was 210 minutes (SD 75.5; range, 93-420). The mean blood loss was 153 mL (SD 165; range, 25-1000). The mean uterine size was 608 g (SD 367; range, 106-1834). There were no surgical complications directly attributed to morcellation. The literature search yielded 22 articles describing outcomes after transvaginal morcellation, with a total of 1953 morcellated specimens.
CONCLUSIONS
Transvaginal uterine morcellation appears to be a safe alternative to laparotomy for the removal of large uterine specimens in select patients.
Topics: Adult; Aged; Blood Loss, Surgical; Female; Humans; Leiomyoma; Middle Aged; Morcellation; Operative Time; Organ Size; Retrospective Studies; Uterine Neoplasms; Uterus
PubMed: 26005318
DOI: 10.4293/JSLS.2014.00255 -
Turkish Journal of Obstetrics and... Dec 2021We sought to analyze all high-quality studies available regarding the possible differences in contained and uncontained techniques for morcellation of fibroids and...
We sought to analyze all high-quality studies available regarding the possible differences in contained and uncontained techniques for morcellation of fibroids and uteri. We systematically searched PubMed, Cochrane Central, Scopus, ClinicalTrials.Gov, MEDLINE and Web of Science from September 2010 to September 2020 for our search terms. We included studies that specifically enrolled patients undergoing power morcellation myomectomy or power morcellation hysterectomy procedures. In our search, we had no restriction to age, country, or publication date. We extracted data related to study design, baseline characteristics of patients, and perioperative outcomes such as total operative time, total blood loss, and duration of hospital stay. We found no substantial difference in total operative time between contained power morcellation and uncontained manual morcellation myomectomy (p=0.52), but contained power morcellation had a significantly longer total operative time than uncontained power morcellation for hysterectomy and myomectomy [135.50 vs. 93.33 minutes, (p=0.003)]. Total blood loss was comparable for contained power morcellation versus uncontained manual morcellation myomectomy (p=0.32) and contained power morcellation versus uncontained power morcellation myomectomy or hysterectomy (p=0.91). Contained power morcellation and uncontained manual morcellation myomectomy had comparable hospital stay periods (p=0.5). Contained power morcellation leads to a longer operating time than uncontained power morcellation for both hysterectomy and myomectomy. No differences were found in comparisons of blood loss, operative time, or comparison to manual methods of morcellation.
PubMed: 34955114
DOI: 10.4274/tjod.galenos.2021.50607 -
BMJ (Clinical Research Ed.) Dec 1993Since the first clinical operation in June 1990 laparoscopic nephrectomy for benign renal disease has become widely accepted. Although the laparoscopic operation takes...
Since the first clinical operation in June 1990 laparoscopic nephrectomy for benign renal disease has become widely accepted. Although the laparoscopic operation takes much longer than open surgery, there are considerable reductions in the length of postoperative hospital stay and the time taken to return to normal activities and to full recovery. Major complications were relatively common in early operations, but with more experience morbidity has been reduced. Laparoscopic nephrectomy for malignant renal disease is still controversial, largely because of the fear of release of malignant tissue into the abdominal cavity during the morcellation and retrieval of the diseased kidney. To prevent this, the kidney is removed intact through a 5-7 cm incision. Long term follow up is needed, however, before we will know whether the laparoscopic procedure is effective in preventing recurrence of cancer. New developments have improved various technical aspects of the operation, but stringent assessment of new techniques is necessary so that the medical community can decide which procedures should become routine practice.
Topics: Humans; Kidney Diseases; Kidney Neoplasms; Laparoscopy; Nephrectomy
PubMed: 8281096
DOI: 10.1136/bmj.307.6917.1488 -
The National Medical Journal of India 1997The authors report on their experience of vaginal hysterectomy in a prospective series of 14 patients with myomatous uteri of the size of 14 to 20 weeks' gestation. The...
The authors report on their experience of vaginal hysterectomy in a prospective series of 14 patients with myomatous uteri of the size of 14 to 20 weeks' gestation. The mean uterine volume at the time of surgery was that of 16 1/2 weeks' gestation. The largest myoma had a diameter of 11.6 cm. Five of the patients were also scheduled to undergo bilateral oophorectomy. The paracervical tissues were infiltrated with a dilute solution of lignocaine and adrenaline. Circumferential incision and reflection of the vaginal wall, dissection of the bladder cephalad, opening of the vesico-uterine fold anteriorly and the pouch of Douglas posteriorly were performed initially. This was followed by clamping, division and ligation of the sacro-uterine and cardinal ligaments and of the uterine vessels, as is done during a vaginal hysterectomy. The next step depended on the size and other features of the uterine corpus and included bisection, myomectomy, morcellation and coring. BISECTION: The cervix was grasped on both sides and the uterus was bisected sagittally towards the fundus, using a knife. The bisection, carried out first along the posterior uterine wall, was aided by the repeated repositioning of the vulsella close to the apex of the incision, combined with rotation of the cervical portion of the uterus around the public arch. If necessary, the uterus was rotated back to its original position and the bisection pursued anteriorly. Complete bisection often allowed half the uterus to be delivered through the vagina and the ovarian pedicle to be secured; the same was then done with the other half of the uterus. Myomectomy was frequently combined with bisection or morcellation. Smaller myomas were removed in one piece while larger ones were morcellated and removed in fragments, one of the vulsella always being attached to the residual bulk of the myoma. Morcellation was carried out on the uterus when despite bisection or myomectomy no further descent was possible. Bisection was recommenced as soon as further descent of the uterus could be achieved after myomectomy and morcellation. Coring was performed instead of bisection when dealing with smaller uteri without any distinct large myoma. A circumferential incision was made at the level of the uterine isthmus about 5 mm into the substance of the corpus. A central core of tissue around the uterine cavity was then excised by progressively undercutting the serosal surface of the uterus towards the fundus. Once the uterus was delivered into the vagina, the hysterectomy was completed in the usual fashion. All 14 procedures with or without oophorectomy or salpingo-oophorectomy were completed successfully. The mean weight of the uteri was 639 g (range 380-1100 g), the mean operating time was 84 minutes (range 30-150 minutes) and the mean operative blood loss was estimated at 296 ml (range 100-800 ml). One patient was given a blood transfusion immediately postoperatively. Six women had macroscopic haematuria that cleared up within 24 hours. There were no other important complications. Postoperative hospital stay averaged 3.7 days (range 2-9 days). Only 2 patients remained in hospital for more than 4 days after surgery. All women had recovered fully by the time of their follow up appointment.
Topics: Contraindications; Female; Humans; Hysterectomy, Vaginal; Patient Selection; Uterus
PubMed: 9230602
DOI: No ID Found -
Ugeskrift For Laeger Sep 2021Parasitic myomas are fibromyomas without anatomical relation to the uterus. It is a rare condition mostly described after laparoscopic fibroid morcellation. This is a...
Parasitic myomas are fibromyomas without anatomical relation to the uterus. It is a rare condition mostly described after laparoscopic fibroid morcellation. This is a case report of a patient with a symptomatic abdominal mass eight years after total abdominal hysterectomy. A parasitic myoma was found in relation to coecum and removed laparoscopically. The condition should be considered in symptomatic women with previous fibroid surgery.
Topics: Female; Fibroma; Humans; Hysterectomy; Laparoscopy; Leiomyoma; Morcellation; Uterine Neoplasms
PubMed: 34596516
DOI: No ID Found