Journal of Pelvic Medicine and Surgery

From the Department of Obstetrics and Gynecology, New Hanover Regional Medical Center, Coastal Area Health Education Center, Wilmington, North Carolina. Reprints: John L. Powell, MD, FACOG, FACS, Department of Obstetrics and Gynecology, New Hanover Regional Medical Center, Coastal Area Health Education Center, 2131 South 17th Street, Wilmington, NC 28402. E-mail: [email protected].

John L. Powell

Powellʼs Pearls: Chandra Kumar Naranbhai Patel, Ph.D. (1938–)

鲍威尔的珍珠：钱德拉·库马尔·纳兰巴伊·帕特尔博士（1938年生）

In Brief In the following commentary, we illustrate the development and use of a low cost model for training residents in the instrumentation, surgical technique, and recognition of normal and abnormal findings during cystourethroscopy. Cystourethroscopy privileges are a necessary skill for the practicing gynecologist and, with reduced work hours during training, the use of models outside the operating room is becoming increasingly important. It is unclear what the minimum curriculum should include and whether use of this model or others translates to increased intraoperative skills and competency. The authors describe the development and use of a low cost model for training residents in the instrumentation, surgical technique, and recognition of normal and abnormal findings during cystourethroscopy.

C Bryce Bowling

W Jerod Greer

Thomas L. Wheeler

Kimberly A. Gerten

R Edward Varner

Holly E. Richter

A Low Cost Cystoscopy Teaching Model

低成本膀胱镜教学模型

In Brief Pelvic organ prolapse is a common problem in females with bladder exstrophy, where alterations in the supporting structures of the pelvic floor are present. Urinary continence rates after successful reconstruction of the urogenital tract are approximately 80% to 90%.1 This population is at high risk for recurrence of incontinence and prolapse. We describe a patient with repaired congenital bladder exstrophy who presented with total uterovaginal prolapse and mixed urinary incontinence, stress predominant. She underwent a total abdominal hysterectomy with bilateral salpingoophorectomy, abdominal sacralcolpopexy, transobturator taping, and cystoscopy complicated by subsequent unilateral obstructive uropathy. Treatment of this obstruction eventually required unilateral ureteral reimplantation. The patient is now 29 months postoperative and is reporting excellent results, with no evidence of prolapse and no report of stress incontinence. A patient, with reconstructed bladder exstrophy, presented with prolapse and stress incontinence. She underwent a TAH/BSO, abdominal sacralcolpopexy, and transobturator sling, complicated by a partial unilateral obstructive uropathy.

Susan Barr

Mary McLennan

The Anatomic and Surgical Challenge of Treating a Patient With Stress Incontinence, Uterovaginal Prolapse, and a History of Congenital Bladder Exstrophy

压力性尿失禁、子宫阴道脱垂及先天性膀胱外翻患者治疗的解剖与手术挑战

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Laura C. Skoczylas

Patricia A. Wallace

Elizabeth R. Burton

Felicia L. Lane

In-Office Placement of Rectovaginal Fistula Plugs

门诊放置直肠阴道瘘塞

In Brief Rectosigmoid endometriosis is a relatively rare condition and may commonly mimic carcinoma. We report a case presenting with frozen pelvis that was unresectable during an emergency laparotomy. Clinically and radiologically it was suspected to be carcinoma and the patient was subjected to radio- and chemotherapy. The lesion was resected during a second laparotomy and was found to be endometriotic mass. A high index of suspicion is necessary to diagnose this condition. A very high index of suspicion is crucial to diagnose recto-sigmoid endometriosis, which may mimic carcinoma and evade preoperative diagnosis.

Vijay Naraynsingh

Seetharaman Hariharan

Dilip Dan

Alexander Sinanan

Endometriotic Rectosigmoid Obstruction Presenting With a Frozen Pelvis-Mimicking Carcinoma

子宫内膜异位症引起的直肠乙状结肠梗阻表现为类似癌性冰冻骨盆

In Brief Purpose: Endometrial cancer is the most frequent of gynecologic cancers in developed countries. Recurrence occurred mostly within the 2 years following initial therapy. Distant metastases are rare. This case report shows the clinical interest of 18F fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) in long-term staging of endometrial cancer. Materials and Methods: A 74-year-old woman had undergone surgery and postoperative adjuvant radiotherapy and brachytherapy for an endometrial cancer. After a 12-year complete remission, an increase in tumor marker levels led to further investigations. Results: CT scan discovered a tumor, located under the liver, but with no hepatic lesion. FDG-PET/CT confirmed peritoneal carcinosis and discovered 3 hepatic metastases. Ultrasonography confirmed these findings. Patient underwent surgery for peritoneal carcinosis and one hepatic lesion and radiofrequency ablation for the 2 other hepatic tumors. Tumor marker levels normalized after therapy. CT scan and ultrasonography performed 1 and 3 months after treatment, respectively, led to false-positive results, as confirmed by a negative FDG-PET/CT performed 6 months after treatment. Conclusions: Whole-body FDG-PET contributes to the diagnosis of recurrence from endometrial cancer. It could be an accurate tool to check on early therapeutic success after radiofrequency ablation. Endometrial cancer is the most frequent of gynecologic cancers in developed countries. Whole-body FDG-PET contributes to the diagnosis of recurrence from endometrial cancer. It could be an accurate tool to check on early therapeutic success after radiofrequency ablation.

Raja Sfar

Amina Khiar

Marc Pocard

Rachid Kaci

Abdel Benada

Michele Duet

Ilana Idy-Peretti

Clinical Impact of 18FDG-PET/CT in the Follow-up of Endometrial Cancer

18FDG-PET/CT在子宫内膜癌随访中的临床影响

In Brief Voiding dysfunction is a well-recognized complication following female stress incontinence surgery, which can be extremely distressing to patients. This review discusses the incidence and etiology of postsurgical obstruction, the diagnostic evaluation, management and outcomes after surgical interventions for post-surgical voiding dysfunction.

Priya Padmanabhan

Roger R. Dmochowski

Voiding Dysfunction

排尿功能障碍

In Brief The field of ergonomics is limited in scope and practice for the gynecologic surgeon. When used correctly, ergonomic principles should enhance worker performance and minimize injury. Given the broad range of operative approaches in gynecology (from vaginal to open abdominal to minimally invasive), coupled with a rapid expansion in developing technologies, safety and efficiency are of the utmost importance not only for the patient, but for the operative staff and surgeons. Based on institutional experience, we present some strategies to improve the ergonomic environment in the operating room, to help lessen personal fatigue and injury for gynecologic surgeons in the 21st century. Ergonomic principles are presented for the gynecologic surgeon in an effort to enhance safety and prevent personal injury.

Kathie L. Hullfish

Elisa R. Trowbridge

Gail Bodine

Ergonomics and Gynecologic Surgery

人机工程学与妇科手术

In Brief Objectives: Joshua Lawrence Chamberlain, a hero of the Union during the American Civil War, suffered a major urologic injury in battle. Because of his recent resurgence of fame, there has been interest in his survival from a devastating pelvic wound. The literature has described his treatment as involving a possibly unprecedented repair of the proximal urethra and/or bladder neck. We have reexamined the primary and secondary literature to define, as far as we can determine for the first time, exactly what was done at the time of his injury. Methods: We reviewed available primary and secondary sources, including Chamberlain's letters and writings, regarding the time of his wounding and subsequent care, comparing these documents with current urologic management of such injuries. Results: Chamberlain's treatment was determined by the then current principles of treatment of urethral and bladder injuries. An invasive reconstruction would have been inconsistent with the abilities and practice of the times. The life-saving procedure referred to by many sources was both crucial and simple: an ultimately successful catheterization of a badly damaged proximal urethra and/or bladder neck. Conclusions: The treatment of Chamberlain's wound was difficult but in principal straightforward. Given the technical limitations of the time, this treatment is fully consistent with both modern and urologic principles of 150 years ago. Colonel Joshua Lawrence Chamberlain, a Civil War hero, received a devastating pelvic wound in 1984. The field hospital treatment that saved his life was not an innovative reconstructive procedure, as previously suggested, but a difficult bladder catheterization. The consequences of the wound and its treatment plagued him throughout his long life.

Deborah J. Lightner

Bruce A. Evans

The Pelvic Wound of Joshua Lawrence Chamberlain Revisited

约书亚·劳伦斯·张伯伦的骨盆伤口再探

In Brief Previous reports in the literature have identified Actinomyces sp. as a complication associated with vaginal mesh erosion following pelvic floor reconstruction. Several of these cases have reported success with long-term penicillin treatment in conjunction with vaginal mesh excision. We report a case of vaginal mesh erosion linked to Actinomyces following abdominal sacrocolpopexy in a penicillin-allergic patient. A 68-year-old postmenopausal woman underwent an abdominal sacrocolpopexy with polypropylene mesh and a midurethral sling for recurrent vaginal vault prolapse and stress-urinary incontinence. Three months postoperatively, she was found to have 0.5-cm graft erosion at the anterior vaginal cuff. Pathology of the exposed mesh revealed Actinomyces. Due to a penicillin allergy, a 9-month course of doxycycline was initiated with subsequent successful removal of the remaining mesh with no residual infection. To our knowledge, this is the first report using doxycycline as adjunctive treatment for Actinomyces complicating vaginal mesh erosion. This case report describes the successful treatment of recurrent mesh erosion complicated by Actinomyces in a penicillin-allergic patient using prolonged treatment with doxycycline in conjunction with delayed surgical resection.

Benjamin J. Steinberg

Adanna L. Anyikam

Karolynn T. Echols

Treatment of Persistent Vaginal Erosion due to Actinomyces Infection in a Penicillin-Allergic Patient

青霉素过敏患者因放线菌感染所致持续性阴道糜烂的治疗

Publication Information	Publisher: Lippincott Williams and Wilkins Ltd.，Publishing cycle: ，Journal Type: journal，Open Access Journals: No
Basic data	Year of publication: 2003，Proportion of original research papers: ，Self Citation Rate:， Gold OA Rate:

Journal of Pelvic Medicine and Surgery

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