In the UK, some 2.3 million people suffer cerumen ('ear wax') problems serious enough to warrant management, with approximately 4 million ears syringed annually. Impacted cerumen is a major cause of primary care consultation, and a common comorbidity in ENT patients, the elderly, infirm and people with mental retardation. Despite this, the physiology, clinical significance and management implications of excessive and impacted cerumen remain poorly characterized. There are no well-designed, large, placebo-controlled, double-blind studies comparing treatments, and accordingly, the evidence surrounding the management of impacted cerumen is inconsistent, allowing few conclusions. The causes and management of impacted cerumen require further investigation. Physicians are supposed to follow the edicts and principles of evidence-based medicine and clinical governance. Currently, in patients with impacted cerumen, the lack of evidence makes this impossible.
Interventions: Study population was split into two different groups: patients who underwent ureterolysis only (Group 1) and patients needing a stent positioning due to surgical procedure (Group2). Measurements/Results: 128 women underwent surgery with ureterolysis only (GP1), 61 women needed a ureteral stent due to more invasive surgery (GP2), used stent positioning as a marker for aggressive surgery on the ureter. We observed that more invasive surgery on the ureter occurred in older patients (41.2 yrs ± 5.54; p = 0.0001), with concomitant involvement of the ipsilateral ovary (p = 0.043), retrocervix (p = 0.008), ipsilateral parametrium (p = 0.0001), sigmoid (p = 0.003), rectovaginal septum (p = 0.013) and bladder (p = 0.0003). Additional bladder surgery was performed in 19.7% GP2 vs 3.12% GP1 (p = 0.0003). Additional bowel surgery was peformed in a high percentage of patients (GP1 68.75%; GP2 73.8% p = 0.05) but bowel resection was performed more often in GP1 (89.8%) than GP2 (62.2%) (p = 0.0003). Conversely bowel nodule shaving was performed more in GP2 (37.8% vs 10.2; p = 0.0003). We calculated the mean sonographic distance of the major nodule from the anal verge to be 12 ± 2.86 cm in GP1 and 9 ± 3 cm in GP2 (p = 0.0001). Conclusions: We found a significant association between parametrial endometriosis (p = 0.0001), sigmoid (0.003), retrocervix (0.008) and the need of intensive surgery on the ureter. Caudal rectal nodule was related to an higher risk of parametrial involvement and major ureteral surgery. However in this case, predominant asymmetrical parametrial disease did not require aggressive bowel surgery.
cystectomy. Among all patients, 53% presented with urinary symptoms and the overall preoperative CA-125 value was 42.5 IU/l. The mean surgical time was 162.8 minutes with a median intraoperative bleeding of 69.1 ml. The overall AFSr score was 32. Twelve percent presented with associated endometrioma, 32% required posterior vaginal fornix resection and 67% had associated intestinal disease that were treated predominantly by discoid (35.8%) and segmental (52.2%) resections. The mean hospital stay was 27.2 hours. Sixteen percent of the patients presented with postoperative by reoperations (3%), rectal bleeding (3%) and abdominal wall hematoma (3%). One patient presented with urinary tract infection and no complications related to bladder suture were found. Conclusions: Laparoscopic resection of bladder endometriosis is an effective, secure and feasible technique, with fewer complications related to bladder reparation.
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