The source of chronic pelvic pain may be reproductive organ, urological, musculoskeletal - neurological, gastrointestinal, or myofascial. A psychological component almost always is a factor whether as an antecedent event or presenting as depression as result of the pain.
Dr. Dubuisson stated that there is is a great demand from patients for minimally invasive surgery and it is important that the surgeon apply certain conditions to the selection of patients for successful treatment of leiomyomas by laparoscopy. Dr. Dubuisson said that the indications for a safe laparoscopic myomectomy include the following:
bout 30% of those with blocked tubes have proximal obstruction. Blockage where the tubes connect to the uterus. This may be due to adhesions, spasm of the opening from the uterus to the tube (tubal osteum) or dryed up dead cells and mucus. The first probably can't be helped. We often see it with a condition called SIN (salpingitis isthmica nodusum) seen after sever pelvic infection. Spasm means the tubes are not really blocked but they show up that way. It's the dried up stuff blocking the tube that makes a difference.
OBGYN.net Conference CoverageFrom American Association of Gynecological LaparoscopistsOrlando, Florida, November 2000. "AAGL The Founding Years" Jordan Phillips, MD, OBGYN.net Editorial Advisor and General Chairman andFounder of AAGL with Dr. Louis Keith, MD OBGYN.net Editorial Advisor
Laparoscopy has been steadily replacing laparotomy because the abdomen does not have to be opened up, resulting in faster recovery and reduction of complications. In laparoscopy, only three small incisions are made for the entry of a small camera and other instruments. Thus, the operation that is taking place inside the abdomen/pelvis can be viewed on a video screen placed next to the operating table.
An ectopic pregnancy is a pregnancy implanted in an abnormal location (outside of the uterus). During the past 40 years its incidence has been steadily increasing concomitant with increased STD rates and associated salpingitis (inflammation of the Fallopian tubes). Such abnormalities of the tubes prevent normal transport of the fertilized egg to the uterus.
Endometrium refers to the tissue lining the uterus. The primary function of the endometrium is to participate in the implantation of the fertilized ovum and the subsequent formation of the maternal portion of placenta.
Even though the anterior repair is the most commonly utilized operation for correction of a cystocele, it is probably not the most effective, nor is it the correct operation for restoring a woman's anatomy and maintaining vaginal length and function. The problem with using this operation in young healthy sexually active woman with a paravaginal defect (cystocele) is the surgeon does not really surgically support the bladder, but instead reduces the bulge by "scrunching " the fascia under the bladder together.
Hysterectomy is the most frequently performed operation in women, with a life time risk varying from country to country from less than 20% to more than 40%. Overall these differences reflect more medical practice than differences in pathology between countries.
Whenever the surgery that is considered can be performed equally well and equally safely by either laparoscopy or laparotomy, the decision as to the type of incision to be used can (and in my opinion really should) include the patient.
Chronic pelvic pain and/or associated intestinal disturbance are a major cause of misery for thousands of patients. Often in constant pain, the patient experiences loneliness, hopelessness, frustration and desperation with thoughts of suicide. Family and work relationships are strained to the limit. Although ADHESIONS are often (but not always) the cause of this pain, treatment for adhesions is not performed either because the surgeon does not believe that adhesions can cause the problem, or because lysis of adhesions is considered too difficult or futile.
FAQs on Infertility from Malpani Infertility Clinic
I had an interesting email come in the a few weeks ago from a woman looking for advice on finding a doctor:
Fibroids are the most common benign tumors of the uterus. These noncancerous growths are present in 20-40% of women over the age of 35. In some women, the fibroids can become enlarged and cause symptoms of excessive bleeding and pain. While the classic treatment of symptomatic fibroids has been surgical removal of the fibroids (myomectomy) or the uterus (hysterectomy) recent advances now afford a nonsurgical treatment.
Ovarian cysts are enlargements of the ovary that appear to be filled with fluid. They can be a simple fluid filled bleb or contain complex internal structures. The term cyst is used to differentiate them from solid enlargements. Simple cysts have no internal structures and are less worrisome than those with complex structures or solid components. A sonogram or ultrasound test can determine if a cyst is simple or complex.
Cystitis is defined as an inflammation of the bladder, and may be caused by such things as bruising, as in the case of ‘Honeymoon Cystitis’, sexually transmitted diseases, or even a reaction to ‘personal care’ products.
Around 153 million women around the world have chosen to be sterilized for contraceptive purposes, of these 138 million are in the developing countries. 1 Approximately fifty percent of all female sterilization is performed during the puerperal period or a cesarean section, and the other fifty percent is called “interval sterilization” when there has been no pregnancy for the previous six weeks.
Uterine fibroid is a slowly growing benign smooth muscle tumor. Approximately 25% of women after the age of 35 years harbor uterine fibroid. Most of these women are asymptomatic and in general, they do not need any treatment
Because endometriosis is a common disease entity among infertile patients with a prevalence of up to 50%, one could argue that without laparoscopy clinical work-ups can not completely rule out all of the causes of infertility. The decision to perform laparoscopy on patients with infertility is very complex owing to a number of factors, such as maternal age, semen parameters, tubal patency, pelvic symptoms, insurance coverage, surgical risks, and availability of surgical expertise.
Endometriosis is one of the most common gynecologic disorders and is significantly more prevalent in the setting of infertility. The prevalence of endometriosis in infertile women ranges from 25% to 50% compared to 5% in fertile women. Successful laparoscopic management of all stages of endometriosis was reported as early as 1986. This has revolutionized the management of endometriosis. The benefits of surgical therapy for infertility associated with endometriosis have been well documented.
The most important requirement for successful hysteroscopy is satisfactory distension of the uterus. While many different media have been used, recent advances in equipment have greatly simplified the use of saline for diagnostic and simple operative hysteroscopy that does not require the use of electrosurgical instruments.
A new committee opinion from the American College of Obstetricians and Gynecologists has concluded that the popular antibiotics used to treat UTIs - sulfonamides and nitrofurans - may be given during the first trimester in the absence of an alternative treatment and may be used as first-line agents during the second and third trimesters. Do you prescribe antibiotics to pregnant patients?
It is usually quite simple to find the cause of abnormal menstrual bleeding, although occasionally the cause may not be found. Since abnormal uterine bleeding can be caused by disorders of the uterus, hormone imbalance (usually not ovulating), and pregnancy, it is helpful to look at each area separately. When I see someone for abnormal bleeding, I ask the following questions.
Currently there are two ways to treat endometriosis – hormonal therapy and surgery. Depending on the patient’s expectations and the extent of the disease, we may prescribe hormonal therapy, surgery, a combination of surgery and hormonal therapy, or occasionally a just “wait and see” approach.
Approximately 750,000 hysterectomies are performed annually in the United States, with a mortality rate of about 12 per 10,000 operations.1 Costs to consumers and insurers have been estimated at approximately $1.7 billion per year.2 Thus, alternative procedures that are safer and less invasive, preserve the uterus, and cost less are increasingly in demand. In recent years, several such techniques have been introduced.
