Gabriel N. Schaer

• Professor
• University Hosptial of Zurich

Background: Social media platforms, such as Facebook and Instagram, are increasingly being used to share health-related information by "influencers," regular users, and institutions alike. While patients may benefit in various ways from these interactions, little is known about the types of endometriosis-related information published on social med...

Anhand 4 exemplarischer Fälle stellen wir interessante Krankheitsbilder aus dem Gebiet der Urogynäkologie vor, mit denen Sie in der Praxis konfrontiert werden können. Hinter geläufigen Symptomen wie Inkontinenz, Schmerzen oder erschwerter Miktion verstecken sich häufig nicht alltägliche Diagnosen. Wir geben einen spannenden Einblick zu den urogynäk...

Cervical cancer represents a particular burden when affecting women in their fertile years. Fertility‐sparing surgery such as trachelectomy can maintain a woman`s childbearing ability. Favorable outcomes are possible, as depicted in this case. image

BACKGROUND Social media platforms, such as Facebook and Instagram, are increasingly being used to share health-related information by “influencers,” regular users, and institutions alike. While patients may benefit in various ways from these interactions, little is known about the types of endometriosis-related information published on social media...

https://www.sggg.ch/fachthemen/expertenbriefe/

Introduction and hypothesis Unrecognized bladder perforation of a tension-free sling is a rare situation. Removal of the intravesical sling has been done by laparotomy or transurethrally. With technique presented here we want to show a minimally invasive approach that allows complete removal of the intraluminal sling material, located at the bladde...

Introduction and hypothesis The use of an appropriate uterine manipulator is key to various laparoscopic gynecologic procedures. Adequate uterine manipulation is important for total or supracervical laparoscopic hysterectomies, laparoscopic sacrocolpopexy as well as laparoscopic repair of vaginal vault prolapse. While several uterine manipulators a...

Introduction: The terminology for female pelvic floor prolapse (POP) should be defined and organized in a clinically-based consensus Report. Methods: This Report combines the input of members of two International Organizations, the International Urogynecological Association (IUGA) and the International Continence Society (ICS), assisted at inter...

Laparoscopic sacrocolpopexy is a well-established technique to treat apical vaginal prolapse. De novo micturition disorders, pelvic pain and defecation disorders have been reported and may be due to intraoperative compromise of the superior hypogastric plexus. The video demonstrates our technique for nerve-sparing laparoscopic sacrocolpopexy. The p...

Several series have demonstrated the feasibility, safety, and efficacy of laparoscopic sacrocolpopexy. Nonetheless, complications such as mesh erosion into the bladder can occur years after primary surgery, with accidental cystotomy during the primary operation appearing to be a risk factor for later mesh erosion. Over the last 10 years we have tre...

Introduction Sacrocolpopexy is considered a gold standard to cure apical prolapse, and since the US Food and Drug Administration (FDA) warning about complications of vaginal mesh surgery, the technique is increasingly used. Surgeons perform sacrocolpopexy in different variations, some by attaching the mesh to the apical third of the vagina, and oth...

This study evaluates the long-term results of laparoscopic sacrocolpopexy. In a prior publication, we demonstrated that laparoscopic sacrocolpopexy is a safe method with excellent anatomical results and low recurrence rates after a 12-month follow-up. This study now evaluates the long-term objectives and subjective outcomes of laparoscopic sacrocol...

Background The presence of lymph node metastases is the most important prognostic factor in early stage breast cancer. Whether bone marrow micrometastases (BMM) impact the prognosis in sentinel lymph node (SLN)–negative breast cancer patients remains a matter of debate. Therefore, the objective of this study was to assess the impact of BMM on 5-yea...

To compare surgical outcome and quality of life of robot-assisted laparoscopic hysterectomy with conventional laparoscopic hysterectomy. For this controlled clinical trial, patients with benign indications for hysterectomy were randomized to receive either a robotic (robotic group) or conventional laparoscopic hysterectomy (conventional group). The...

A terminology and standardized classification has yet to be developed for those complications related to native tissue female pelvic floor surgery. This report on the terminology and classification combines the input of members of the Standardization and Terminology Committees of two International Organizations, the International Urogynecological A...

A terminology and standardized classification has yet to be developed for those complications related to native tissue female pelvic floor surgery. This report on the terminology and classification combines the input of members of the Standardization and Terminology Committees of two International Organizations, the International Urogynecological A...

Introduction and hypothesisA terminology and standardized classification has yet to be developed for those complications arising directly from the insertion of synthetic (prostheses) and biological (grafts) materials in female pelvic floor surgery.Methods This report on the above terminology and classification combines the input of members of the S...

a terminology and standardized classification has yet to be developed for those complications arising directly from the insertion of synthetic (prostheses) and biological (grafts) materials in female pelvic floor surgery. this report on the above terminology and classification combines the input of members of the Standardization and Terminology Com...

Objective: Robotic surgery, with its technical advances, promises to open a new window to minimally invasive surgery in gynaecology. Feasibility and safety of this surgical innovation have been demonstrated in several studies, and now a critical analysis of these new developments regarding outcome and costs is in place. So far only a few studies c...

Operationen bei Beckenbodeninsuffizienz sollten konzeptionell angegangen werden. Die Grundlage dazu bilden die Beschwerden der betroffenen Frau und die Ansprüche an Funktionalität von Vagina, Blase und Darm. Es gilt zudem die anatomischen Defekte richtig zu beurteilen, da darauf die Entscheidung zugunsten einer Operationstechnik oder von Kombinatio...

It is recommended to perform pelvic floor prolapse surgery within a concept which bases on the women's symptoms, the expectations on life quality and functional aspects of the vagina, urinary bladder and rectum. Decisions on type of surgery must also be founded on the anatomical defect. An apical prolapse should either be fixed by sacrospinous liga...

Next to existing terminology of the lower urinary tract, due to its increasing complexity, the terminology for pelvic floor dysfunction in women may be better updated by a female-specific approach and clinically based consensus report. This report combines the input of members of the Standardization and Terminology Committees of two international o...

Next to existing terminology of the lower urinary tract, due to its increasing complexity, the terminology for pelvic floor dysfunction in women may be better updated by a female-specific approach and clinically based consensus report. This report combines the input of members of the Standardization and Terminology Committees of two International O...

Uterine tumors resembling ovarian sex-cord tumors are very rare uterine neoplasias that generally behave in a benign manner. We report the case of a uterine tumor resembling an ovarian sex-cord tumor that recurred after hysterectomy. A 35-year-old nulliparous woman presented with abdominal discomfort, galactorrhea and abnormal vaginal bleeding. Ult...

This study was carried out to determine whether five experts in female stress urinary incontinence (SUI) could discover a pattern of urethrovesical movement characteristic of SUI on dynamic perineal ultrasound. A secondary analysis of data from a case-control study was performed. Ultrasounds from 31 cases (daily SUI) and 42 controls (continent volu...

Advanced breast cancer screening techniques and their availability increased the number of non-palpable breast lesions requiring surgery. Consequently reliable and efficient therapeutic management permitting accurate localization and removal of these occult lesions is essential. In our study we evaluated radioguided occult lesion localization (ROLL...

Our prospective study evaluates laparoscopic sacrocolpopexy for vaginal vault prolapse focusing on perioperative data, objective anatomical results using the pelvic organ prolapse quantification (POP-Q) system and postoperative quality of life using the Kings Health questionnaire. One hundred one patients completed the study. Fifty five had laparos...

To assess the accuracy of sentinel lymph node (SLN) frozen section in a prospective multicenter study of early-stage breast cancer patients. The decision to perform an immediate completion axillary node dissection (ALND) is based on results of SLN frozen section. However, SLN frozen sections are not routinely performed in all centers. Moreover, the...

The sentinel lymph node (SLN) status has proven to accurately reflect the remaining axillary lymph nodes and represents the most important prognostic factor. It is unknown whether an association exists between the SLN status and the presence of bone marrow (BM) micrometastases. The objective of the present investigation was to evaluate whether or n...

Urinary tract infections are generally diagnosed by test strips and microscopic semi-quantitative sediment analyses. However, results are uncertain because of lacking standardisation and limited sensitivity in low-count-bacteriuria. Flow cytometry UF-100 was used to analyse particles quantitatively in urine in women with urinary tract infections du...

To assess the morbidity after sentinel lymph node (SLN) biopsy compared with SLN and completion level I and II axillary lymph node dissection (ALND) in a prospective multicenter study. ALND after breast cancer surgery is associated with considerable morbidity. We hypothesized: 1) that the morbidity in patients undergoing SLN biopsy only is signific...

In this prospective, nonrandomized, ongoing study we evaluated the efficacy and safety of botulinum-A toxin injections in the detrusor muscle to treat patients with idiopathic overactive bladder resistant to conventional treatment, such as anticholinergic drugs. A total of 23 men and 77 women with a mean age of 63 years (range 24 to 89) with nonneu...

Quintessenz b Die Belastungsinkontinenz tritt bei körperlicher Betätigung mit abdominaler Druckerhöhung auf. b Die hyperaktive Blase ist eine Störung der Blasenfüllung (sensorisch oder motorisch). b Anamnese, Hustentest und klinische Untersuchung sind die Eckpfeiler der Basisdiagnostik und genügen meist, um eine Basistherapie einzuleiten. b Die Bel...

Ultrasound is a supplementary, indispensable diagnostic procedure in urogynecology; perineal, introital, and endoanal ultrasound are the most recommended techniques. The position and mobility of the bladder neck can be demonstrated. In patients undergoing diagnostic work-up for urge symptoms, ultrasound occasionally demonstrates urethral diverticul...

Forty patients who underwent a single tension-free vaginal tape procedure were evaluated by perineal ultrasound both pre- and postoperatively in a prospective observational clinical study. The positions of the tape, bladder neck and urethra were sonographically documented at rest and during Valsalva maneuvers. During Valsalva the tape rotated towar...

Since urinary incontinence is one of the most frequent female health problems and may severely affect a woman's life quality, knowledge about its pathophysiology, evaluation and therapy is very important. Even basic diagnostic tests can determine the type of incontinence (stress or urge urinary incontinence) thus permitting appropriate therapy to b...

Da die Harninkontinenz zu den häufigsten Erkrankungen der Frau gehört, sind Kenntnisse zu Pathophysiologie, Diagnostik und Therapie dieser die Lebensqualität beeinflussenden Erkrankung von großer Wichtigkeit. Schon mit der Basisdiagnostik gelingt es meist, die Diagnose zu stellen und erste Therapieschritte einzuleiten. Anamnese, Miktionskalender, k...

The purpose of the study was to measure the thickness and cross-sectional area of urethral muscle layers to identify localized striated muscle loss. The urethra and surrounding tissues from 25 female cadavers (mean age, 52 +/- 18 [SD] years; range, 15-80 years) were used for this study. Axial and median sagittal histologic sections were prepared. M...

To evaluate the mobility of the vesical neck during coughing and valsalva in healthy nulliparous volunteers and to test the reliability of the technique applied. Clinical observational study. Department of Obstetrics and Gynaecology, Cantonal Hospital Lucerne, Switzerland. Thirty-nine nulliparous volunteers. Vesical neck motion was assessed with pe...

Ultrasound is a complementary evaluation for the study of female urinary incontinence which allows functional-morphological documentation. With sonography dynamic images during coughing, Valsalva, pelvic floor contraction and micturition are provided. Ultrasonography of the urethrovesical anatomy improves our thinking of function and anatomy and wi...

The aim of this study was to describe normal characteristics of spontaneous and voluntary pelvic muscle function in nulliparous healthy continent women and to assess the reaction of the pelvic floor to stress and fatigue. Ten nulliparous volunteers were recruited. Pelvic muscle strength was evaluated by palpation and perineal ultrasound. Kinesiolog...

To determine whether 3D ultrasound examination of pelvic floor anatomy after vaginal delivery allows detection of childbirth trauma. Pelvic floor anatomy was examined in 16 women during the puerperium with a 3D transrectal ultrasound probe. Images were acquired via the vaginal route for the assessment of anal morphology and the transrectal route to...

To investigate the differential diagnostic capacity of the frequency-volume chart in 132 women with urinary incontinence. For each patient, the readings of two 24-h frequency-volume charts were compared to the urodynamic diagnosis which was used as the gold standard in 73 genuine stress incontinent women, in 23 urge incontinent women, and in 36 wom...

Objective: To evaluate a new sonographic method to measure depth and width of proximal urethral dilation during coughing and Valsalva maneuver and to report its use in a group of stress-incontinent and continent women. Methods: Fifty-eight women were evaluated, 30 with and 28 without stress incontinence proven urodynamically, with a bladder volu...

A remote-controlled steering arm was developed that allows the ultrasound probe to be held on the perineum under ultrasound image guidance with the woman seated on a commercially available bedside commode. The arm's servomechanism monitors contact pressure between the scanning head and the perineum, keeping constant gentle pressure on the perineum...

To examine the anatomic identity of sonographically visible sphincteric structures of the female urethra. The urethra, urinary bladder, and vagina were removed from 11 fresh female cadavers and placed in a water bath. Intraurethral ultrasound was performed with a 360 degrees-rotating 7.5-MHz ultrasound probe. Afterward, the specimens were fixed and...

Ultrasound evaluation in urogynaecology has evolved. Comparison with the old standard, lateral chain urethrocystography, as well as basic investigations of the sonographic technique and standardizations have created a basis for a new imaging standard and for further developments in urogynaecology. The recent progress indicates that sonography holds...

Objective: To describe the sonographic appearance of normal anal sphincter anatomy and sphincter defects evaluated with a conventional 5 MHz convex transducer placed on the perineum. Design: Prospective, single-blind study. Setting: Department of Obstetrics and Gynecology, University of Michigan Medical Center, USA. Population: Twenty-five w...

To evaluate pelvic floor muscle strength before and after vaginal birth. Prospective repeated measures study. Main district hospital. Fifty-five women: 25 primiparae and 20 multiparae following vaginal birth, and 10 women following elective caesarean delivery as a control group. Pelvic muscle strength was evaluated by palpation, perineometry and pe...

Objective To evaluate pelvic floor muscle strength before and after vaginal birth. Design Prospective repeated measures study. Setting Main district hospital. Population Fifty-five women: 25 primiparae and 20 multiparae following vaginal birth, and 10 women following elective caesarean delivery as a control group. Methods Pelvic muscle strength was...

Objective To describe the sonographic appearance of normal anal sphincter anatomy and sphincter defects evaluated with a conventional 5 MHz convex transducer placed on the perineum. Design Prospective, single-blind study. Setting Department of Obstetrics and Gynecology, University of Michigan Medical Center, USA. Population Twenty-five women with s...

To correlate urodynamic with perineal sonographic findings in pressure variations. In 15 women presenting with urethral pressure variations a urodynamic evaluation with water filling cystometry, urethral pressure at rest and during coughing and uroflowmetry were performed. During water filling cystometry, there were simultaneous perineal video-sono...

A COMPARISON AIM: To determine how well results of gynecological and perineal sonographic examinations of the urethrovesical junction correlate. 186 women with urodynamically verified stress incontinence underwent a perineal ultrasound and then a gynecologic examination. Standardised procedures were used for both. The findings of the gynecological...

To assess changes in urethral movement during the Valsalva maneuver and pelvic floor muscle contraction following vaginal delivery. In a prospective repeated-measures study, 25 primigravidas, 20 multiparas, and ten women who were to have elective cesarean delivery were examined sonographically at 36-42 weeks of pregnancy and 6-10 weeks after delive...

Das Seminar sollte dem Dialog von Wissenschaft (Labor) und Klinik (Praxis) dienen und sollte auch und vor allem auf die notwendige Kommunikation zwischen Praxis (Anamnese, Diagnostik) und gynäkologischer Histopathologie (unter Einschluß neuerer molekularbiologischer Verfahren) hinweisen.

Die weibliche Harninkontinenz ist eine häufige und die Lebensqualität einschränkende Erkrankung. Eine sorgfältige Diagnostik ist für das Fällen des richtigen Therapieentscheides entscheidend. Nach internationalem Standard gilt zudem, daß vor jeder Inkontinenzoperation eine urodynamische Untersuchung durchgeführt werden muß. Diese Untersuchung soll...

Unlabelled: A COMPARISON AIM: To determine how well results of gynecological and perineal sonographic examinations of the urethrovesical junction correlate. Method: 186 women with urodynamically verified stress incontinence underwent a perineal ultrasound and then a gynecologic examination. Standardised procedures were used for both. The finding...

Die Anzeichen häufen sich, daß die sonographische Diagnostik des unteren Harntraktes im Rahmen der urogynäkologischen Funktionsdiagnostik aus ihren Kinderschuhen entwachsen ist. Vergleiche mit dem alten radiologischen Standard, Basisuntersuchungen zur sonographischen Methodik und die neuesten Empfehlungen der AUG helfen Klarheit in diesem Bereich z...

37 cases of extragenital tumours metastatic to the ovaries are analysed from a clinicopathological viewpoint. In 25 out of 334 patients who were operated on between 1978 and 1990 because of a palpable malignant ovarian tumour, ovarian involvement from extragenital cancer was diagnosed. The most frequent primary sites were the stomach (n = 7), colon...

This is a report on the fundamentals of perineal ultrasound examination for female incontinence. The measurement method described here enabled us to determine the position of the bladder neck, the size of the retrovesical angle beta and the occurrence of funnelling. In four different investigations, each involving at least 30 patients, we investiga...

To evaluate applicability, acceptance, side effects and complications and the possible curative effect on female stress urinary incontinence of the treatment with the urethral plug VIVA (Braun Melsungen, Germany). Part I: Prospective clinical study. Part II: Ongoing prospective-longitudinal study. Additionally two case reports. Part II: 156 consecu...

To assess the efficacy of ultrasound medium when imaging bladder neck anatomy with perineal ultrasound. In 10 female patients with urinary stress or stress-urge incontinence, a new echogenic contrast medium (Echovist) was intravesically administered and perineal ultrasound performed. The examination was done with the women in the upright position b...

Ultrasound is a complementary evaluation for the study of female urinary incontinence which allows functionalmorphological documentation. A reliable urogynecologic examination is based on the patient's history, clinical evaluation, urodynamics and imaging. Training in sonography of the female lower urinary tract should be performed within the scope...

In einer Studie zur Therapie der weiblichen Streßharninkontinenz mit dem VIVA®-Urethrastöpsel wurde festgestellt, daß 62% von 156 untersuchten Frauen aus der urodynamischen Sprechstunde den Stöpsel im Stehen beim Husten behalten konnten (Stöpseltest). Die Gruppe der Frauen, die den Stöpsel halten konnte, unterschied sich nur durch den max. Urethrav...

The Stewart-Treves syndrome is an angiosarcoma that occurs due to chronic lymphoedema which in most cases is a complication after mastectomy with axillary node dissection and postoperative radiation. Prognosis for this rare tumour is poor. The best therapy is early and radical excision. Chronic lymphoedema seems to be an important pathogenetic fact...

To determine whether the term "fractional D&C" is justified with respect to the uterine cervix and corpus fractions, and what indications and results are found when a large population at a university hospital is analyzed. In this retrospective study covering a 3-year period at the Department of Gynecology, University Hospital of Zurich, indications...

Diagnosis and therapy of gynecologic inpatients who were over 80 years of age were analyzed with respect to the desired and the actual management. A general assessment protocol for diagnostic and therapeutic steps which were not carried out in individual cases was drawn up and used for the 96 patients analyzed. The desired therapy corresponded to t...

Our purpose was to determine and compare the total annual costs for reusable and single-use laparoscopic instruments. Records were kept over a 12-month period of all laparoscopic operations (performed only with reusable instrumentation), the surgical instruments used, depreciation costs, and all associated expenses (repairs, maintenance, replacemen...

Perineal ultrasound was used with a new measurement method that locates the urethrovesical junction. The aim of this study was to test the reproducibility of this examination. Two different investigators examined 40 patients at rest and during Valsalva's manoeuvre. Using a rectangular coordinate system, the bladder neck was located by means of dist...

To assess the efficacy of ultrasound contrast medium when imaging bladder neck anatomy in perineal ultrasound. In 39 women with clinically and urodynamically proven urinary stress or stress-urge incontinence, a new echogenic contrast medium (Echovist) was administered transurethrally and perineal ultrasound was performed. Women were examined in the...

ZusammenfassungFragestellung: Diagnostik und Therapie von über 80jährigen stationär behandelten gynäkologischen Patientinnen wurden prospektiv untersucht und einer «Soll-Ist-Analyse» unterzogen. Methoden: Es wird ein allgemeines Beurteilungsschema für nicht durchgeführte diagnostische und therapeutische Schritte vorgestellt und auf die Situation de...