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Journal of Medical Radiation Sciences Jun 2020Vaginal dilation is often indicated as an intervention for the management of radiation therapy-induced vaginal adhesions and stenosis (RTVAS). However, limited research...
INTRODUCTION
Vaginal dilation is often indicated as an intervention for the management of radiation therapy-induced vaginal adhesions and stenosis (RTVAS). However, limited research exists underpinning this intervention and diversity in patient recommendations internationally are reported. In the absence of New Zealand (NZ) national guidelines regarding the management of RTVAS, a survey of NZ radiation therapy departments was conducted to gain an overview of current practice.
METHODS
A two-section online survey was developed to capture RTVAS education and management overview across NZ. Section one focused on departmental resourcing and section two on local standard practice regarding vaginal dilator usage. One RTVAS education representative from each department was invited to complete the survey.
RESULTS
Eight of nine NZ departments completed the survey. Consistent treatment indications were identified for RTVAS patient education with the involvement of diverse staffing groups at various time-points throughout the treatment process. Protocols for RTVAS management existed in each RT department with staff commonly trained by informal peer observation. Dilator usage was recommended regardless of patient sexual activity. Agreement was shown regarding the recommended start time of dilator usage and frequency. The recommended duration of dilator use post-treatment varied from 6 months to greater than 36 months.
CONCLUSIONS
This work illustrates both concordance and diversity in practice and contributes to the limited body of literature available. Further research is warranted to explore patterns of practice between departmental protocols and individual practitioners in further detail.
Topics: Constriction, Pathologic; Female; Humans; New Zealand; Pelvic Neoplasms; Radiation Injuries; Vagina
PubMed: 32267099
DOI: 10.1002/jmrs.386 -
Journal of the Turkish German... 2016Retrospective analysis of cases that have undergone neovagina operation because of congenital vaginal agenesis was objected.
OBJECTIVE
Retrospective analysis of cases that have undergone neovagina operation because of congenital vaginal agenesis was objected.
MATERIAL AND METHODS
Seven cases applying with the complaints of primary amenorrhea or inability to have sexual intercourse were in the study. The cases were diagnosed with congenital vaginal agenesis and operated at Mustafa Kemal University Training and Research Hospital between 2011 and 2014. Vaginoplasty by the modified McIndoe method was performed in all cases. The main complaint, chromosomal analysis, duration of operation, preoperative and postoperative vaginal length, complications, postoperative treatment, and satisfaction from the sexual intercourse were all evaluated.
RESULTS
Average age of our patients was 28.14±8.61 (19-39) years. One patient was 46XX-45X0 mosaic Turner syndrome), 1 patient was 46XY (testicular feminization), and other 5 patients were 46XX. The average duration of operation was 2.7±0.56 (2-3.5 h). Postoperative infection was observed in 1 patient. In this infected patient, graft failure occurred and debridement was performed in reoperation. No early complications were seen in the others. Preoperative and postoperative average vaginal lengths were 1.85±0.62 (1-3 cm) and 8.71±1.11 (7-10 cm), respectively. Dyspareunia occurred in 2 cases that were not able to use dilatator regularly: 1 because of cancelation of marriage and the other because of postoperative infection; regular sexual life was achieved in remaining 5 (71%) cases.
CONCLUSION
Although there is no consensus about the ideal method of making a functioning vagina among different specialties. The modified McIndoe technique is the most applied method by gynecologists and simple, minimally invasive and with low morbidity.
PubMed: 27403077
DOI: 10.5152/jtgga.2016.16013 -
PloS One 2019To propose a consensus for prevention of vaginal stenosis in patients submitted to pelvic radiotherapy.
OBJECTIVE
To propose a consensus for prevention of vaginal stenosis in patients submitted to pelvic radiotherapy.
METHOD
In this methodological study, Delphi technique was applied for content validation on vaginal stenosis prevention. Data regarding content validation were collected from 32 specialists practicing in the oncology profession. The content validity index of items in the consensus was calculated based on the evaluations by the specialists.
RESULTS
In the first round, of the 38 items evaluated, 29 items reached a Content Validity Index (CVI-I) greater than 80%, and 9 items had a CVI lower than 80%. Of the items that did not obtain agreement, 2 items were excluded, and 7 were reformulated and included in the second round. In the second round, all 7 items obtained a CVI-I greater than 80%. The final instrument consisted of 29 items validated in the first round, plus 7 items reformulated and consolidated in the second round. The judges agreed that it is the responsibility of the health professionals to consult the patients undergoing radiation therapy in the area of sexuality to patients. The radiation oncologist should be the first professional to address this issue and the nurse oncologist in the follow-up consultation should pass the guidelines to the patients as comprehensively as possible. Patients should be informed about vaginal dilation, regardless of whether they are sexually active or have a partner. They should also be informed of when they can resume sexual activity. The procedure of vaginal dilation should be individualized. The prescribed vaginal dilators should be used with a lubricant for a duration of at least 5-10 minutes, 2-3 times a week, as per the need of each patient (sexual activity and/or clinical follow-up) for an indefinite time. Patients should seek medical help in case they experience pain, discomfort, or bleeding during dilation.
CONCLUSION
The Brazilian version of the consensus for vaginal stenosis prevention in patients submitted to pelvic radiotherapy was validated with 36 items in 7 categories related to Responsibility; Target population; Rationale; Vaginal dilator; Content instructions; Information provision; and Patient support. In Brazil, the educational practices on vaginal dilation for patients submitted to radiotherapy partly revealed similar difficulties as identified in other studies as well as countries with reference to specific guidelines for the start and duration of vaginal dilation. The final consensus developed in this study could strengthen the guidelines for education of patients in Brazil and provide a future scope to establish a single and safe guideline.
Topics: Adult; Aged; Brazil; Consensus; Constriction, Pathologic; Female; Humans; Middle Aged; Netherlands; Pelvis; Vagina
PubMed: 31398239
DOI: 10.1371/journal.pone.0221054 -
Fertility and Sterility Dec 2016To provide a review of the literature regarding this technique as well as a step-by-step description with the goal of increasing its use as a safe surgical option.... (Review)
Review
OBJECTIVE
To provide a review of the literature regarding this technique as well as a step-by-step description with the goal of increasing its use as a safe surgical option. Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome is characterized by vaginal agenesis and a variety of mullerian duct anomalies. To date, a variety of procedures have been described for creating a neovagina, but the best treatment remains debated. The Wharton-Sheares-George method, a minimally invasive surgical approach for the creation of a neovagina, is remarkably simple to perform.
DESIGN
Surgical video tutorial.
SETTING
University hospital and referral center for pediatric and adolescent gynecology.
PATIENT(S)
A 20-year-old woman with MRKH syndrome who underwent Wharton-Sheares-George neovaginoplasty.
INTERVENTION(S)
With the Wharton-Sheares-George neovaginoplasty the rudimentary müllerian ducts are dilated incrementally by pushing Hegar dilators in the direction of the pelvic axis, and the resulting median raphe is then intersected using diathermy. Subsequently a vaginal mold is inserted into the newly created cavity and held in position by two sutures.
MAIN OUTCOME MEASURE(S)
Discussion of the surgical steps according to the Wharton-Sheares-George method and review of the anatomic and functional results.
RESULTS
Reviewing the existing literature shows that a mean vaginal length and width of 8.3 and 3.3 cm, respectively, can be achieved, and so far no major intraoperative or postoperative complications or prolapse of the neovagina has been reported. Patients can achieve a high degree of general well-being as well as sexual and psychosocial functioning. However, as with most other methods, the presented method requires diligent patient compliance due to the lifelong need to actively avoid contraction of the neovagina. Also, as revealed by vaginal cultures and biopsies, the neovaginas remarkably resemble natural vaginas with regard to type of bacterial colonization and structure of epithelium. The process of spontaneous epithelialization of the neovagina is not fully understood, but has been observed to begin at the vaginal orifice and take several months to reach the apex. This leads to the assumption that the nonkeratinizing, stratified squamous epithelium originates from the preexisting vaginal epithelium of the vaginal dimple and migrates in a cranial direction. Alternatively, epithelialization might arise from pluripotent stem cells located in the obliterated müllerian ducts.
CONCLUSION(S)
The creation of a neovagina using the Wharton-Sheares-George method does not require allogenic or autologous transplants, nor does it require traction devices or specialized surgical equipment. Furthermore, the procedure is comparatively simple to perform and easy to learn. By following our step-by-step description of this technique, surgeons can offer a minimally invasive, quick, and safe surgical option that provides long-term results that are both functionally and anatomically satisfying. We believe that this technique represents a valuable alternative for the creation of a neovagina in patients with MRKH syndrome and thus should be investigated on a broader scale in the future.
Topics: 46, XX Disorders of Sex Development; Congenital Abnormalities; Female; Gynecologic Surgical Procedures; Humans; Mullerian Ducts; Plastic Surgery Procedures; Surgically-Created Structures; Treatment Outcome; Vagina; Young Adult
PubMed: 27678038
DOI: 10.1016/j.fertnstert.2016.08.030 -
BMC Cancer Jan 2020The incidence of anal cancer is rising in the last decades and more women are affected than men. The prognosis after chemoradiation is very good with complete remission... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
The incidence of anal cancer is rising in the last decades and more women are affected than men. The prognosis after chemoradiation is very good with complete remission rates of 80-90%. Thus, reducing therapy-related toxicities and improving quality of life are of high importance. With the development of new radiotherapy techniques like IMRT (Intensity-modulated radiotherapy), the incidence of acute and chronic gastrointestinal toxicities has already been reduced. However, especially in female anal cancer patients genital toxicities like vaginal fibrosis and stenosis are of great relevance, too. Up to now, there are no prospective data reporting incidence rates, techniques of prevention or impact on quality of life. The aim of the DILANA trial is to evaluate the incidence and grade of vaginal fibrosis, to optimize radiotherapy by reducing dose to the vaginal wall to minimize genital toxicities and improve quality of life of anal cancer patients.
METHODS
The study is designed as a prospective, randomized, two-armed, open, single-center phase-II-trial. Sixty patients will be randomized into one of two arms, which differ only in the diameter of a tampon used during treatment. All patients will receive standard (chemo) radiation with a total dose of 45-50.4 Gy to the pelvic and inguinal nodes with a boost to the anal canal up to 54-60 Gy. The primary objective is the assessment of the incidence and grade of vaginal fibrosis 12 months after (chemo) radiation depending on the extent of vaginal dilation. Secondary endpoints are toxicities according to the CTC AE version 5.0 criteria, assessment of clinical feasibility of daily use of a tampon, assessment of compliance for the use of a vaginal dilator and quality of life.
DISCUSSION
Prospective studies are needed evaluating the incidence and grade of vaginal fibrosis after (chemo) radiation in female anal cancer patients. Furthermore, the assessment of techniques to reduce the incidence of vaginal fibrosis like intrafractional vaginal dilation as well as other radiotherapy-independent methods like using a vaginal dilator are essential. Additionally, implementation of a systematic assessment of vaginal stenosis is necessary to grant reproducibility and comparability of future data.
TRIAL REGISTRATION
The trial is registered with clinicaltrials.gov (NCT04094454, 19.09.2019).
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anus Neoplasms; Chemoradiotherapy; Female; Humans; Middle Aged; Pelvic Neoplasms; Prognosis; Prospective Studies; Quality of Life; Radiation Injuries; Radiotherapy Dosage; Radiotherapy, Intensity-Modulated; Vaginal Diseases; Young Adult
PubMed: 31964381
DOI: 10.1186/s12885-020-6547-7 -
Frontiers in Pediatrics 2022Vaginal adhesions and stenosis are infrequent long-term sequelae following pediatric pelvic fractures. Patients may not present with signs and symptoms before menarche,...
Vaginal adhesions and stenosis are infrequent long-term sequelae following pediatric pelvic fractures. Patients may not present with signs and symptoms before menarche, leading to delayed diagnosis and treatment. We report an adolescent girl who presented with a post-abdominal trauma pelvic fracture and urethrovaginal fistula and subsequent severe vaginal adhesion, which resulted in infection and obstructive symptoms after menarche. Hysteroscopy-guided vaginal adhesion release using an epidural catheter and ultrasonography was performed, followed by vaginal dilation, to resolve obstructive symptoms. For girls with pelvic fractures, education on possible long-term sequelae is required, as is regular follow-up. Timely diagnosis and treatment are important, and hysteroscopic release of vaginal adhesion and postoperative regular vaginal dilation may be an effective treatment.
PubMed: 36340718
DOI: 10.3389/fped.2022.966724 -
Fertility and Sterility May 2020To compare sexual function and outcomes of quality of life of patients with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome after vaginal dilation and surgical procedures. (Comparative Study)
Comparative Study
Sexual function and quality of life after the creation of a neovagina in women with Mayer-Rokitansky-Küster-Hauser syndrome: comparison of vaginal dilation and surgical procedures.
OBJECTIVE
To compare sexual function and outcomes of quality of life of patients with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome after vaginal dilation and surgical procedures.
STUDY DESIGN
Cross-sectional study from January 2019 to June 2019.
SETTING
Tertiary teaching hospital.
PATIENT(S)
Women with MRKH syndrome treated with vaginal dilation (n = 88) or surgical procedures (n = 45).
INTERVENTION
WeChat-based questionnaires were distributed to every group member in our MRKH support group.
MAIN OUTCOME MEASURE(S)
Sexual functional were assessed by means of the Female Sexual Function Index (FSFI). Outcomes of quality of life were assessed by means of the 12-item World Health Organization Disability Assessment Schedule 2 (WHODAS2). Vaginal length was defined as the maximum depth of the placement of the vaginal mold.
RESULT(S)
The FSFI scores were similar between the dilation (24.49 ± 4.51) and surgery (23.79 ± 3.57) groups. Except for the higher orgasm score in the dilation group (9.96 ± 3.60 vs. 8.20 ± 2.67), the other dimensions of the FSFI were not significantly different between the groups. No significant differences were found in the WHODAS2 scores between the dilation group (median 8.33 [interquartile range 4.17-15.62]) and the surgery group (6.25 [2.08-14.58]). However, the vaginal length was significantly shorter in the dilation group (6.5 ± 2.04 cm) than in the surgery group (8.1 ± 1.59 cm).
CONCLUSION(S)
Although the vaginal length was shorter in the dilation therapy group than in the surgical therapy group, sexual function and quality of life were similar between these two groups. Vaginal dilation should be proposed as the first-line therapy for MRKH patients.
Topics: 46, XX Disorders of Sex Development; Adult; Congenital Abnormalities; Cross-Sectional Studies; Dilatation; Female; Gynecologic Surgical Procedures; Humans; Mullerian Ducts; Patient Satisfaction; Quality of Life; Plastic Surgery Procedures; Sexual Behavior; Surgically-Created Structures; Surveys and Questionnaires; Treatment Outcome; Vagina; Young Adult
PubMed: 32386614
DOI: 10.1016/j.fertnstert.2020.01.017 -
European Journal of Obstetrics,... Jun 2021To evaluate the association between lactate concentrations in fetal blood samples and the different advanced labour stages.
AIM
To evaluate the association between lactate concentrations in fetal blood samples and the different advanced labour stages.
METHODS
Eighteen-month prospective population-based clinical study of 187 singleton pregnant women in labour who were monitored by fetal blood sampling (FBS) because of non-reassuring intrapartum CTG results at Kuopio University Hospital, Finland. Peripheral lactate concentration and pH were analysed at different stages of labour and in umbilical arterial samples immediately after delivery.
RESULTS
FBS samples (N = 350) were obtained from 5.4 % of all women in labour during the study period, and 48 % had spontaneous delivery, 27 % had vacuum-assisted vaginal delivery, and 25 % had nonelective Caesarean delivery. FBS lactate levels increased 4-11% with every 1-2 cm of cervical dilation and 18 % from early labour to fully dilated cervix. In 42 women with at least two FBSs, lactate levels increased significantly from the early I stage of labour and up to a fully dilated cervix. Lactate values were significantly higher in umbilical arterial samples compared to FBSs. Sensitivity of the highest FBS lactate values for the detection of birth asphyxia were considerably low varying between 42.9-57.1%.
CONCLUSION
FBS lactate levels were related to the stage of labour during vaginal delivery attempt. Wide range of lactate levels during labour complicates its use as a predictor of birth asphyxia.
Topics: Cesarean Section; Delivery, Obstetric; Female; Fetal Blood; Finland; Humans; Infant, Newborn; Labor, Obstetric; Pregnancy; Prospective Studies
PubMed: 33934025
DOI: 10.1016/j.ejogrb.2021.04.032 -
Journal of Education & Teaching in... Apr 2024Uterine perforation is a rare but potentially life-threatening complication of gynecologic procedures. Serious complications include hemorrhage, infection, and injury to...
UNLABELLED
Uterine perforation is a rare but potentially life-threatening complication of gynecologic procedures. Serious complications include hemorrhage, infection, and injury to surrounding organ systems (eg, gastrointestinal, urological, vascular, etc.). Risk factors include advanced maternal age, prior gynecologic surgeries, and other anatomical features that impact the difficulty of accessing the uterine cavity. In this case report, we discuss a patient who presented to the emergency department (ED) with diffuse abdominal pain and vaginal bleeding that occurred after an elective dilation and curettage (D&C) for a termination of pregnancy. The diagnosis was suspected clinically and confirmed by imaging including ultrasound (US) and computed tomography (CT) of the abdomen and pelvis. The patient was managed operatively with a multidisciplinary approach including Gynecology, General Surgery, and Urology. The patient was stabilized and eventually discharged. Uterine perforation should be included in the differential for patients with a history of recent gynecologic instrumentation presenting with abdominal pain and vaginal bleeding. The stabilization of these patients requires aggressive volume resuscitation, controlling the source of bleeding, and emergent surgical consultation.
TOPICS
Gynecology, vaginal bleeding, ultrasound, computed tomography.
PubMed: 38707940
DOI: 10.21980/J83643 -
British Medical Journal Apr 1949
Topics: Dilatation; Equipment and Supplies; Female; Humans; Vagina
PubMed: 18118585
DOI: No ID Found