Publications (3)5.94 Total impact
Article: Female Urethral Diverticula[Show abstract] [Hide abstract]
ABSTRACT: Transvaginal excision of UD is the gold-standard therapy, but success depends on proper staging by determination of the extent and number of diverticula and attention to surgical technique. MRI provides excellent visualization of the UD in several planes and has greatly improved the ability to assess this condition. No debate exists regarding proper surgical technique. The principles of complete excision of the UD, watertight and tension-free closure, and no overlapping suture lines are endorsed by all surgical descriptions. It has been shown that the concomitant performance of pubovaginal sling surgery does not increase the risks for erosion into the urethra and fistula formation.
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ABSTRACT: A systematic approach to the repair of cystoceles using interposition grafting is discussed. Surgeons' opinions vary regarding which graft material is most appropriate. The choices for mesh interposition include synthetic, xenograft, autograft (free full thickness vaginal wall), and allograft materials. Long-term data are not available to support the use of one material over another; however, an abundance of literature has documented results of different materials used in urethral sling surgery, and these data are important to consider. Although a review of biomaterial selection is beyond the scope of this article, the authors favor porcine dermis xenografts. Defect repair may be addressed with a single-component interposition graft, which serves as a bladder base and urethral support , or with a two-component interposition using different grafts for the sling and the anterior compartment repair. The authors favor the latter approach. High-grade cystocele repair using the porcine dermis interposition graft is successful and associated with few complications. Cystocele recurrence is typically low grade and does not require additional surgery.
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ABSTRACT: To explore, by histological examination, whether the uterosacral ligament complex is an adequate support structure for vaginal vault suspension and other reconstructive procedures of the female pelvis. We dissected 14 fresh hemipelves from seven adult female cadavers. The uterosacral complexes were excised from the pelvic sidewall immediately beneath the uterosacral pedicle. The specimens were stained with connective tissue-specific Movat stain and evaluated microscopically for the presence of collagen and/or elastin. Uterosacral tissue similar to that identified during pelvic reconstructive surgery was obtained in all cases. Six of the women had had a hysterectomy. A ligamentous structure with clearly aligned collagen and interspersed elastin was identified in only three specimens, two from one cadaver of a young woman who had not had a hysterectomy. The other specimens had an attenuated, poorly organized layer of collagen immediately beneath the peritoneum. We could not consistently identify normal ligamentous tissue in the uterosacral complexes. The overwhelming majority of specimens from women who had had a hysterectomy showed disorganized tissue with reduced cellularity. This reinforces doubts about the integrity of these tissues as structural supports in pelvic reconstructive surgery, particularly in elderly women who have had a hysterectomy.