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Fernandes MS, Takano CC, Chrispin TTB, Marquini GV, Girão MJBC, Sartori MGF. Three-dimensional Printer Molds for Vaginal Agenesis: An Individualized Approach as Conservative Treatment. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2022; 44:1110-1116. [PMID: 36138536 PMCID: PMC9800147 DOI: 10.1055/s-0042-1756214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 06/14/2022] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the use of vaginal molds, made with three-dimensional (3D) printing, for conservative treatment through vaginal dilation in patients with vaginal agenesis (VA). METHODS A total of 16 patients with a diagnosis of VA (Mayer-Rokitansky-Küster-Hauser syndrome, total androgen insensitivity syndrome, and cervicovaginal agenesis) from the Federal University of São Paulo were selected. Device production was performed in a 3D printer, and the polymeric filament of the lactic polyacid (PLA) was used as raw material. A personalized treatment was proposed and developed for each patient. RESULTS There were 14 patients who reached a final vaginal length of 6 cm or more. The initial total vaginal length (TVL) mean (SD) was 1.81(1.05) and the final TVL mean (SD) was 6.37 (0.94); the difference, analyzed as 95% confidence interval (95% CI) was 4.56 (5.27-3.84) and the effect size (95% CI) was 4.58 (2.88-6.28). CONCLUSION The 3D printing molds for vaginal dilation were successful in 87.5% of the patients. They did not present any major adverse effects and offered an economical, accessible, and reproducible strategy for the treatment of VA.
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Apfel VR, Takano CC, Marquini GV, de Jarmy di Bella ZIK, Girão MJBC, Sartori MGF. Treatment for vaginal agenesis: A prospective and comparative study between vaginal dilation and surgical neovaginoplasty. Int J Gynaecol Obstet 2022; 157:574-581. [PMID: 34534375 DOI: 10.1002/ijgo.13931] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/21/2021] [Accepted: 09/15/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To compare, in terms of anatomical, functional, and sexual aspects, two types of treatment for women with vaginal agenesis: progressive dilation or surgical neovaginoplasty. METHODS Women with vaginal agenesis underwent either dilation treatment using the Frank method or surgical treatment using the modified Abbé-McIndoe technique with oxidized cellulose. Patients were evaluated 3-6 months after treatment for a follow-up including medical history, physical examination, general satisfaction, clinical aspect of the vagina, Female Sexual Function Index, and three-dimensional pelvic floor ultrasound. RESULTS In total, 20 women with vaginal agenesis were included in the present study; nine in the dilation group and 11 in the surgical group. A comparison between the groups (vaginal dilation and surgical neovaginoplasty) showed efficacy in neovagina formation after both treatments, with a statistically significant difference between the pre- and post-treatment periods (P value pre- × post-dilation group <0.0001 and P value pre- × post-surgical group <0.0001). There were no statistical differences in total vaginal length measurements (P value post-dilation × post-surgical = 0.09) or Female Sexual Function Index scores (P = 0.72) after both treatments. CONCLUSION Both treatments had satisfactory efficacy and positive outcomes for patients with vaginal agenesis concerning anatomical, functional, and sexual aspects, with minimum complications in the surgical group. Dilation treatment can remain the first-line therapy.
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Affiliation(s)
- Vanessa R Apfel
- Urogynecology and Vaginal Surgery Sector, Department of Gynecology, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Claudia C Takano
- Urogynecology and Vaginal Surgery Sector, Department of Gynecology, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Gisele V Marquini
- Urogynecology and Vaginal Surgery Sector, Department of Gynecology, Federal University of Sao Paulo, Sao Paulo, Brazil
| | | | - Manoel J B C Girão
- Urogynecology and Vaginal Surgery Sector, Department of Gynecology, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Marair G F Sartori
- Urogynecology and Vaginal Surgery Sector, Department of Gynecology, Federal University of Sao Paulo, Sao Paulo, Brazil
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Cai H, Qiao L, Song K, He Y. Oxidized, Regenerated Cellulose Adhesion Barrier Plus Intrauterine Device Prevents Recurrence After Adhesiolysis for Moderate to Severe Intrauterine Adhesions. J Minim Invasive Gynecol 2016; 24:80-88. [PMID: 27742483 DOI: 10.1016/j.jmig.2016.09.021] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 09/08/2016] [Accepted: 09/22/2016] [Indexed: 01/13/2023]
Abstract
STUDY OBJECTIVE To compare the efficacy of an oxidized, regenerated cellulose adhesion barrier (Interceed; Ethicon, Somerville, NJ) combined with an intrauterine device (IUD) versus an IUD alone for preventing adhesion recurrence following hysteroscopic adhesiolysis for moderate to severe intrauterine adhesions (IUAs). DESIGN Retrospective case series (Canadian Task Force classification III). SETTING Tertiary care teaching hospital. PATIENTS Patients undergoing treatment for moderate to severe IUAs. The severity of IUA was determined based on the American Fertility Society scoring system (mild, moderate, or severe). INTERVENTIONS All cases of hysteroscopic adhesiolysis were reviewed. MEASUREMENTS AND RESULTS Seventy-six women with moderate to severe IUAs treated between March 2009 and August 2015 were included. After hysteroscopic adhesiolysis, 35 patients were treated with an IUD alone (group 1), and 41 patients were treated with Interceed plus an IUD (group 2). A second hysteroscopy was performed in all cases three months after the initial hysteroscopy and both groups achieved significant reduction in adhesion scores and grade, especially in group 2 (scores, p < .001; grade, p = .039). Compared with group 1, menstruation dysfunction, pregnancy rate, and live birth rate in group 2 improved with no statistical difference (menstruation improvement, p = .764; pregnancy rate, p = .310; live birth rate, p = .068). However, an adhesion-free uterine cavity was regained significantly owing to the fewer operations in group 2 compared with group 1 (median, 3 vs 4; p = .001). The interval from initial hysteroscopy to conception was significantly shorter in group 2 (median, 12 months vs 51 months; p < .001). CONCLUSIONS For moderate to severe IUAs, Interceed combined with an IUD may be an alternative approach for reducing adhesion recurrence after hysteroscopic adhesiolysis.
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Affiliation(s)
- Huihua Cai
- Department of Obstetrics and Gynecology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Lin Qiao
- Department of Obstetrics and Gynecology, General Hospital of PLA Guangzhou Military Area, Guangzhou, Guangdong, China
| | - KaiJing Song
- Department of Obstetrics and Gynecology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Yuanli He
- Department of Obstetrics and Gynecology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China.
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Cai H, Li H, He Y. Interceed and Estrogen Reduce Uterine Adhesions and Fibrosis and Improve Endometrial Receptivity in a Rabbit Model of Intrauterine Adhesions. Reprod Sci 2016; 23:1208-16. [PMID: 26895816 DOI: 10.1177/1933719116632923] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Intrauterine adhesions (IUA) remain a major cause of infertility. Interceed, a regenerated cellulose adhesion barrier, is used to prevent adhesions in abdominal cavity. This study aimed to determine whether Interceed could reduce adhesions and tissue fibrosis and improve endometrial receptivity (ER) in rabbit. Rabbits were randomized into 6 groups: sham operation, Interceed control, IUA model, Interceed therapy, estrogen therapy, and combination therapy. Four rabbits per group were euthanized to evaluate adhesion severity on the day before intervention and day 7, 14, and 28 after intervention. Number of endometrial glands and degree of endometrial fibrosis acted as markers for adhesion severity. Pseudopregnancy was induced in the remainder, and 8 rabbits per group were killed for assessing ER on days 6, 7, and 8 of pseudopregnancy by ανβ3 integrin and pinopode. We found that Interceed or estrogen therapy led to significant improvement in the adhesion severity on day 28 after intervention, respectively, compared to IUA model group (all P < .05). However, after combination therapy, such improvement achieved comparable to sham operation group as early as day 14 after intervention (glands, P = .711, fibrosis, P = .154). Among the IUA models treated, ER was highest after combination therapy on day 7 of pseudopregnancy, similar to sham operation group (integrin, P = .352, pinopode, P = .154). In conclusion, Interceed and estrogen reduce adhesions and tissue fibrosis and improve ER in a rabbit model and may be novel therapeutic approaches for infertility resulting from IUA.
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Affiliation(s)
- Huihua Cai
- Department of Obstetrics and Gynecology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Huijuan Li
- Department of Obstetrics and Gynecology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China Department of Obstetrics and Gynecology, Xian XD Group Hospital, Xian, Shanxi, China
| | - Yuanli He
- Department of Obstetrics and Gynecology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
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Çağlar M, Erkal NB, Isenlik BS, Özdemir Ö, Yavuzcan A, Üstün Y, Kumru S. Effect of reproductive characteristics, body mass index, and anterior/posterior vaginal compartment defects on the short-term success of abdominal sacrocolpopexy. J OBSTET GYNAECOL 2014; 35:512-6. [PMID: 25356618 DOI: 10.3109/01443615.2014.970525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Vaginal vault prolapse is caused by the loss of apical support in the cardinal-uterosacral ligament complex. Abdominal sacrocolpopexy (ASCP) is one means of repairing vaginal vault prolapse. In the present study, we investigated the effects of reproductive factors, body mass index (BMI), and anterior or posterior vaginal compartment defects on short-term outcomes of ASCP. METHOD We retrospectively studied 70 women who had undergone ASCP between February 2012 and November 2012 in our clinic. RESULT There were no significant differences in the complication rate among menopausal, nonmenopausal women, and grand multiparous patients. Operational success was not significantly affected by menopausal status. The long-term rate of grade ≥ 2 prolapse in the apical, anterior, or posterior vaginal wall after ASCP did not differ significantly by menopausal status. Correlation analysis showed that BMI was not associated with operational success in the early postoperative period in patients with vaginal prolapse and was not associated with the detection of grade ≥ 2 prolapse in apical, anterior, and posterior compartments after 1 year. CONCLUSION ASCP should be the first-line treatment for obese/overweight, menopausal, or grand multiparous patients with additional anterior or posterior vaginal vault prolapse.
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Affiliation(s)
- Mete Çağlar
- a Department of Obstetrics and Gynecology , Düzce University School of Medicine , Düzce , Turkey
| | - Neslihan Boz Erkal
- b Department of Obstetrics and Gynecology , Antalya Education and Research Hospital , Antalya , Turkey
| | - Bekir Sıtkı Isenlik
- b Department of Obstetrics and Gynecology , Antalya Education and Research Hospital , Antalya , Turkey
| | - Özgür Özdemir
- b Department of Obstetrics and Gynecology , Antalya Education and Research Hospital , Antalya , Turkey
| | - Ali Yavuzcan
- a Department of Obstetrics and Gynecology , Düzce University School of Medicine , Düzce , Turkey
| | - Yusuf Üstün
- a Department of Obstetrics and Gynecology , Düzce University School of Medicine , Düzce , Turkey
| | - Selahattin Kumru
- a Department of Obstetrics and Gynecology , Düzce University School of Medicine , Düzce , Turkey
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Dornelas J, Jármy-Di Bella ZI, Heinke T, Kajikawa MM, Takano CC, Zucchi EV, Girão MJ. Vaginoplasty with oxidized cellulose: anatomical, functional and histological evaluation. Eur J Obstet Gynecol Reprod Biol 2012; 163:204-9. [DOI: 10.1016/j.ejogrb.2012.04.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2011] [Revised: 03/24/2012] [Accepted: 04/30/2012] [Indexed: 10/28/2022]
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