A Randomized Clinical Trial of the Impact of Local Estrogen on Postoperative Tissue Quality After Vaginal Reconstructive Surgery

Karp, Deborah R.; Jean-Michel, Marjorie; Johnston, Yasmin; Suciu, Gabriel; Aguilar, Vivian C.; Davila, G. Willy

doi:10.1097/spv.0b013e31825e6401

Cited by 39 publications

(22 citation statements)

References 7 publications

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“…The decrease in vaginal pH is associated with both reduced symptoms of VA, such as dryness and dyspareunia, and improved cytological condition of the vaginal epithelium [18] . During vaginal examination, the pH strip was placed in the midvaginal position against the posterior vaginal wall for 20 s. The colour change was then compared to a standardised colour chart included with the pH strips 60 s later by the investigator, as previously done by Karp et al [19] in a randomised clinical trial to assess the effect of vaginal oestrogen on postoperative tissue quality after vaginal reconstructive surgery. The vaginal pH was recorded on a standardised sheet.…”

Section: Primary Outcomesmentioning

confidence: 99%

The Effect of Vaginal Oestriol Cream on Subjective and Objective Symptoms of Stress Urinary Incontinence and Vaginal Atrophy: An International Multi-Centre Pilot Study

Weber

Lim

Oryszczyn

et al. 2016

Gynecol Obstet Invest

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Aim: Subjectively and objectively assess stress urinary incontinence (SUI) symptoms before and after topical oestrogen therapy. Methods: A prospective study was performed in 3 centres in South-Africa, Australia and the Netherlands. Postmenopausal women with SUI were treated with topical oestriol cream for 6 weeks. The primary subjective outcome was the Patient's Global Impression of Improvement (PGI-I) scale. The primary objective outcome was vaginal pH. Secondary subjective outcomes were: the International Consultation on Incontinence Questionnaire-Urinary Incontinence-Short Form, the Incontinence Impact Questionnaire, the Urogenital Distress Inventory (UDI-6) and the most bothersome symptom approach. Secondary objective outcome was the erect cough pad test. Compliance was scored. Results: A total of 68 women were enrolled. Half of the participants reported improvement on the PGI-I scale after treatment. Vaginal pH was significantly lower after treatment (median 5.3 (interquartile range (IQR) 4.5-6.0) vs. 5.0 (4.4-5.4), p = 0.002). Improvement on the UDI stress domain was observed (p = 0.01). No statistically significant differences were found in the other subjective outcomes. Baseline and repeat cough pad tests demonstrated a wide variation with no significant difference. Compliance was high (median 100 (IQR 83-100%)). Conclusion: Topical oestriol cream during 6 weeks improved quality of life and vaginal pH but no other objective measures of incontinence.

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Section: Primary Outcomesmentioning

confidence: 99%

The Effect of Vaginal Oestriol Cream on Subjective and Objective Symptoms of Stress Urinary Incontinence and Vaginal Atrophy: An International Multi-Centre Pilot Study

Weber

Lim

Oryszczyn

et al. 2016

Gynecol Obstet Invest

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“…Debate exists around whether asymptomatic Meckel's diverticula, discovered incidentally, require resection. In a population-based, epidemiologic study, Cullen et al suggest the removal of all Meckel's diverticula discovered at the time of surgery, 15 while in a case series of 1,476 patients, Park et al recommend the removal of Meckel's diverticula in patients who are male, aged less than 50 years, where ectopic tissue is present, or where the diverticular length is greater than 2 cm, since these are risk factors for the development of symptoms in the future. 10 The combination of weakened vaginal mucosa coupled with the increased prevalence of chronic medical conditions that impair wound healing, such as diabetes mellitus or chronic renal failure, predispose postmenopausal women to develop vaginal small-bowel evisceration following hysterectomy.…”

Section: Discussionmentioning

confidence: 99%

Vaginal Small-Bowel Evisceration Complicated by Meckel's Diverticulitis

Singh¹,

DeLeon

Elliott

2013

Journal of Gynecologic Surgery

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Background: Vaginal small-bowel evisceration is a known complication following hysterectomy. Meckel's diverticulitis as a possible etiology of vaginal small-bowel evisceration has previously not been described. Case: A 62-year-old Latin-American woman presented with vaginal small-bowel evisceration 4 years after undergoing a total vaginal hysterectomy. The patient underwent resection of a 15 cm segment of nonviable terminal ileum, followed by reanastomosis and repair of the vaginal cuff. Final pathology revealed a necrotic segment of terminal ileum with a ruptured Meckel's diverticulum. Conclusions: Although this patient exhibited risk factors for vaginal small-bowel evisceration such as postmenopausal status and type 2 diabetes mellitus, given the results of the final pathology, we believe that Meckel's diverticulitis significantly contributed to the breakdown of the vaginal cuff and subsequent evisceration of a portion of the small bowel. ( J GYNECOL SURG 29:16)

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“…One study performed by Alphs et al noted similar outcomes between the two techniques [ 20 ]. Finally, we applied estrogen cream to the wound in the immediate postoperative setting to promote healing of the vaginal epithelium [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

A Case of Urethral Diverticulum with Surgical Repair Using Cadaveric Pericardial Tissue

Custer

Jessop

Zaslau

et al. 2018

Case Reports in Urology

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A urethral diverticulum is a relatively uncommon finding. The estimated prevalence is approximately 1-5% in the general population. While the definitive treatment is surgical correction, there are limited studies guiding the best approach to repair. This is the case of a 48-year-old female who initially presented with vaginal discharge, dysuria, and dyspareunia. MRI revealed the diagnosis of suspected urethral diverticulum. The patient was treated with surgical correction with the aid of needle localization prior to the procedure. After the diverticulum was excised, the resulting defect in the urethra was successfully closed with cadaveric pericardial tissue. A urethral diverticulum should be considered in the differential diagnosis when a patient presents with symptoms such as recurrent urinary tract infections (UTIs) vaginal mass, dysuria, dyspareunia, or vaginal discharge. The use of cadaveric tissue augments the surgical technique for repair.

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A Randomized Clinical Trial of the Impact of Local Estrogen on Postoperative Tissue Quality After Vaginal Reconstructive Surgery

Abstract: Early administration of vaginal estrogen after vaginal surgery via an estradiol-releasing ring is feasible and results in improved markers of tissue quality postoperatively compared to placebo and controls.

Cited by 39 publications

References 7 publications

The Effect of Vaginal Oestriol Cream on Subjective and Objective Symptoms of Stress Urinary Incontinence and Vaginal Atrophy: An International Multi-Centre Pilot Study

The Effect of Vaginal Oestriol Cream on Subjective and Objective Symptoms of Stress Urinary Incontinence and Vaginal Atrophy: An International Multi-Centre Pilot Study

Vaginal Small-Bowel Evisceration Complicated by Meckel's Diverticulitis

A Case of Urethral Diverticulum with Surgical Repair Using Cadaveric Pericardial Tissue

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