Öz
OBJECTIVE: Iatrogenic vaginal stenosis adversely affects the sexual life of couples. The definitive treatment of this condition is possible by redilatation of vagina. This study aims to investigate the outcomes of vaginal dilatation procedure performed using an absorbable oxidized regenerated cellulose.
MATERIAL AND METHODS: 29 patients who could not have intercourse due to Iatrogenic vaginal stenosis underwent vagina enlargement surgery using an absorbable oxidized regenerated cellulose in the period of April 2014 to August 2020. The results were analysed with the help of the standard ‘Patient Global Impression of Improvement Scale (PGI-I) which evaluates patient satisfaction in particular.
RESULTS: The mean follow-up period was 16 monts (14 - 24 months). No major perioperative complication was detected except from perianal hemotoma treated with antibiotics and drainage in a case. At 6th month follow up visit, 27 patients reported pain free sexual intercourse. Two patients needed re-dilatation 4 and 6 months later respectively.Based on the scores of patients as “much better ‘’and ‘’very much better” on the PGI-I scale, satisfaction rate was 93% at 6th month follow up visit.
CONCLUSIONS: Vaginal dilatation surgery with absorbable oxidized regenerated cellulose seems to be a safe and effective procedure with positive anatomical and functional results. However, many comparative studies a
Anahtar Kelimeler
Kaynakça
- 1. Vassallo BJ, Karram MM. Management of iatrogenic vaginal constriction. Obstet Gynecol. 2003;102:512–2022.
- 2. Breech LL, Laufer MR. Surgicel in the management of labial and clitoral hood adhesions in adolescents with lichen sclerosus. J Pediatr Adolesc Gynecol. 2000;13(1):21‐22.
- 3. Rouzier R, Haddad B, Deyrolle C, et al. Perineoplasty for the treatment of introital stenosis related to vulvar lichen sclerosus. Am J Obstet Gynecol. 2002;186(1):49-52.
- 4. Wilkinson EJ. Introital stenosis and Z-plasty. Obstet Gynecol. 1971;38:638–40.
- 5. Morley GW, DeLancey JOL. Full-thickness skin graft vaginoplasty for treatment of the stenotic or foreshortened vagina. Obstet Gynecol. 1991;77:485–89.
- 6. Lowder JL, Oliphant SS, Shepherd JP, et al. Genital hiatus size is associated with and predictive of apical vaginal support loss. Am J Obstet Gynecol. 2016;214(6):1-8.
- 7. Yalcin I, Bump RC.Validation of two global impression questionnaires for incontinence. Am J Obstet Gynecol. 2003;189(1):98–101.
- 8. Nichols DH. Posterior colporrhaphy and perineorrhaphy: separate and distinct operations. Am J Obstet Gynecol. 1991;164(3):714‐721.
- 9. Gupta A, Kennedy B, Meriwether KV, et al. "Landmark" Articles in Female Pelvic Medicine and Reconstructive Surgery: Do We Read What We Cite? Female Pelvic Med Reconstr Surg. 2021;27(1):59-63.
- 10. Walters, MK.; MM. Urogynecology and Reconstructive Surgery. 3rd Ed. Elsevier/Saunders; Philadelphia, PA: 2006.
- 11. Magon N, Alinsod R. Female cosmetic genital surgery: delivering what women want. J Obstet Gynaecol India. 2017;67(1):15–19.
- 12. González-Cámpora R, Illanes-Moreno M, Parra-Martín J, et al. Extensive peritoneal histiocytic reaction to oxidized regenerated cellulose. Surgery. 1997;121: 471–473.
- 13. Schnüriger B, Barmparas G, Branco BC, et al. Demetriades.Prevention of postoperative peritoneal adhesions: A review of the literature. Am J Surg. 2011;201: 111–121.
- 14. Sharma JB, Gupta N, Mittal S. Creation of neovagina using oxidized cellulose (surgicel) as a surgical treatment of vaginal agenesis. Arch Gynecol Obstet. 2007;275(4):231‐ 235.
- 15. Dornelas J, Jármy-Di Bella ZI, Heinke T, et al.Vaginoplasty with oxidized cellulose: anatomical, functional and histological evaluation. Eur J Obstet Gynecol Reprod Biol. 2012;163(2):204‐209.
- 16. El-Anwar MW, Nofal AA, Elmalt A. Surgicel use in control of primary postadenoidectomy bleeding. Ear Nose Throat J. 2017;96(9):372-375.
- 17. Yu W, Xu J, Sheng H, et al. [Clinical Evaluation of Absorbable Regenerated Oxidized Cellulose in Lung Cancer Surgery. 2020; 20;23(6):492-495.
- 18. Li H, Cheng F, Chávez-Madero C, Choi J, et al. Manufacturing and physical characterization of absorbable oxidized regenerated cellulose braided surgical sutures. Int J Biol Macromol. 2019 ;1(134):56-62.
- 19. Mittal S, Sharma JB, Gupta N. Successful closure of a bladder neck fistula complicated by urethral and vaginal stenosis, using oxidized cellulose (Surgicel) for reinforcement: a case report. Int Urogynecol J. 2006;17:426–428.
- 20. Paniel BJ, Truc JB, de Margerie V, Chantraine J, Poitout P . La vulvo-périnéoplastie [Vulvo-perineal surgery]. J Gynecol Obstet Biol Reprod. 1984;13(1):91‐100.
Öz
Vajinanın iatrojenik olarak fazla daraltılması, çiftlerin cinsel hayatını olumsuz etkilemektedir. Bu durumun kesin tedavisi ise tekrar vajinanın genişletilmesi ile mümkündür. Bu çalışma, emilebilir oksidize rejenere seluloz kullanılarak uygulanan vajina genişletme işleminin sonuçlarını değerlendirmeyi amaçlamaktadır.
GEREÇ VE YÖNTEM: İatrojenik vajina darlığı nedeniyle ilişkiye giremeyen 29 hastaya, Nisan 2014 ile Ağustos 2020 tarihleri arasında, emilebilir oksidize rejenere seluloz kullanılarak vajina genişletme ameliyatı yapıldı. Bu ameliyatın sonuçları, özellikle hasta memnuniyetini değerlendiren standart ‘’Hasta Memnuniyet Ölçeği’’ yardımıyla incelendi.
BULGULAR: Hastalar, ortalama 16 ay (14 - 24 ay) takip edildi. Drenaj ve antibiyoterapi ile tedavi edilmiş bir perianal hemotom vakası dışında perioperatif dönemde kaydedilmiş majör komplikasyon saptanmadı. Altı haftanın sonunda, 27 hasta ağrısız cinsel ilişkiye girebildiğini belirtti. Iki hastada ise, sırasıyla 4 ve 6 ay sonra, vajina genişletme ameliyatı tekrar uygulandı. Cerrahiden altı ay sonra, memnuniyet ölçeğindeki “daha iyi ‘’ve ‘’çok daha iyi” cevaplarına göre ameliyat sonrası hasta memnuniyet oranı %93 olarak saptandı.
SONUÇ: Emilebilir oksidize rejenere seluloz kullanılarak yapılan vajina genişletme ameliyatı, olumlu anatomik ve fonksiyonel sonuçlara sahip etkili ve güvenilir bir işlem gibi görünmektedir. Ancak, bu yöntemin güvenilirliğinin ve etkinliğinin tam olarak değerlendirilebilmesi için çok sayıda karşılaştırmalı çalışmaya ihtiyaç vardır.
Anahtar Kelimeler
Kaynakça
- 1. Vassallo BJ, Karram MM. Management of iatrogenic vaginal constriction. Obstet Gynecol. 2003;102:512–2022.
- 2. Breech LL, Laufer MR. Surgicel in the management of labial and clitoral hood adhesions in adolescents with lichen sclerosus. J Pediatr Adolesc Gynecol. 2000;13(1):21‐22.
- 3. Rouzier R, Haddad B, Deyrolle C, et al. Perineoplasty for the treatment of introital stenosis related to vulvar lichen sclerosus. Am J Obstet Gynecol. 2002;186(1):49-52.
- 4. Wilkinson EJ. Introital stenosis and Z-plasty. Obstet Gynecol. 1971;38:638–40.
- 5. Morley GW, DeLancey JOL. Full-thickness skin graft vaginoplasty for treatment of the stenotic or foreshortened vagina. Obstet Gynecol. 1991;77:485–89.
- 6. Lowder JL, Oliphant SS, Shepherd JP, et al. Genital hiatus size is associated with and predictive of apical vaginal support loss. Am J Obstet Gynecol. 2016;214(6):1-8.
- 7. Yalcin I, Bump RC.Validation of two global impression questionnaires for incontinence. Am J Obstet Gynecol. 2003;189(1):98–101.
- 8. Nichols DH. Posterior colporrhaphy and perineorrhaphy: separate and distinct operations. Am J Obstet Gynecol. 1991;164(3):714‐721.
- 9. Gupta A, Kennedy B, Meriwether KV, et al. "Landmark" Articles in Female Pelvic Medicine and Reconstructive Surgery: Do We Read What We Cite? Female Pelvic Med Reconstr Surg. 2021;27(1):59-63.
- 10. Walters, MK.; MM. Urogynecology and Reconstructive Surgery. 3rd Ed. Elsevier/Saunders; Philadelphia, PA: 2006.
- 11. Magon N, Alinsod R. Female cosmetic genital surgery: delivering what women want. J Obstet Gynaecol India. 2017;67(1):15–19.
- 12. González-Cámpora R, Illanes-Moreno M, Parra-Martín J, et al. Extensive peritoneal histiocytic reaction to oxidized regenerated cellulose. Surgery. 1997;121: 471–473.
- 13. Schnüriger B, Barmparas G, Branco BC, et al. Demetriades.Prevention of postoperative peritoneal adhesions: A review of the literature. Am J Surg. 2011;201: 111–121.
- 14. Sharma JB, Gupta N, Mittal S. Creation of neovagina using oxidized cellulose (surgicel) as a surgical treatment of vaginal agenesis. Arch Gynecol Obstet. 2007;275(4):231‐ 235.
- 15. Dornelas J, Jármy-Di Bella ZI, Heinke T, et al.Vaginoplasty with oxidized cellulose: anatomical, functional and histological evaluation. Eur J Obstet Gynecol Reprod Biol. 2012;163(2):204‐209.
- 16. El-Anwar MW, Nofal AA, Elmalt A. Surgicel use in control of primary postadenoidectomy bleeding. Ear Nose Throat J. 2017;96(9):372-375.
- 17. Yu W, Xu J, Sheng H, et al. [Clinical Evaluation of Absorbable Regenerated Oxidized Cellulose in Lung Cancer Surgery. 2020; 20;23(6):492-495.
- 18. Li H, Cheng F, Chávez-Madero C, Choi J, et al. Manufacturing and physical characterization of absorbable oxidized regenerated cellulose braided surgical sutures. Int J Biol Macromol. 2019 ;1(134):56-62.
- 19. Mittal S, Sharma JB, Gupta N. Successful closure of a bladder neck fistula complicated by urethral and vaginal stenosis, using oxidized cellulose (Surgicel) for reinforcement: a case report. Int Urogynecol J. 2006;17:426–428.
- 20. Paniel BJ, Truc JB, de Margerie V, Chantraine J, Poitout P . La vulvo-périnéoplastie [Vulvo-perineal surgery]. J Gynecol Obstet Biol Reprod. 1984;13(1):91‐100.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Klinik Tıp Bilimleri |
| Bölüm | Makaleler-Araştırma Yazıları |
| Yazarlar | |
| Yayımlanma Tarihi | 20 Nisan 2022 |
| Kabul Tarihi | 5 Temmuz 2021 |
| Yayımlandığı Sayı | Yıl 2022 Cilt: 23 Sayı: 2 |
Kaynak Göster
