1
|
Lin YX, Kong WM. Effects of vaginal dilation therapy on vaginal condition and sexual function of endometrial cancer patients treated with radiotherapy after surgery. J Obstet Gynaecol Res 2024; 50:485-493. [PMID: 38097390 DOI: 10.1111/jog.15857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 11/29/2023] [Indexed: 12/20/2023]
Abstract
OBJECTIVE This study aimed to evaluate the effect of vaginal dilation therapy on vaginal length, vaginal stenosis, vaginal elasticity, and sexual function of endometrial cancer patients treated with radiotherapy after surgery. METHODS A total of 117 women were enrolled in this study. They received 6 months of vaginal dilation therapy. We evaluated their vaginal length, vaginal diameter, vaginal elasticity, and sexual function before radiotherapy, after radiotherapy, and after 6 months of vaginal dilation therapy. Their vaginal condition was assessed by customized vaginal dilating molds. Their sexual function was assessed by female sexual function index. The SPSS 25 software was used to analyze all the data. RESULTS According to multivariate analysis, vaginal diameter (β = 0.300, 95% CI [0.217-1.446], p = 0.010) and sexual intercourse frequency before diagnosis (β = 0.424, 95% CI [0.164-0.733], p = 0.006) were significantly correlated with female sexual function after radiotherapy. Vaginal dilation therapy helped increase vaginal length, improve vaginal stenosis and sexual function (p < 0.05), though most of the figures at the end of the intervention did not fully return to those before radiotherapy. Noticeably, vaginal dilation therapy was ineffective in improving vaginal elasticity and the incidence rate of female sexual dysfunction (p > 0.05). Moreover, patients with medium or good vaginal elasticity benefited more from vaginal dilation therapy than patients with poor vaginal elasticity (p < 0.05). CONCLUSION Vaginal dilation therapy should be carried out timely and preventatively in endometrial cancer patients treated with radiotherapy after surgery to improve their vaginal condition and sexual function.
Collapse
Affiliation(s)
- Yu-Xuan Lin
- Department of Gynecology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Wei-Min Kong
- Department of Gynecology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, China
| |
Collapse
|
2
|
Mushtaq A, Woodrum DA, Thompson SM, Bjarnason H, Bendel E, Tran N(BV, Langstraat CL. Vaginal stenosis treatment using computed tomography and fluoroscopy guidance. AJOG Glob Rep 2023; 3:100257. [PMID: 37701754 PMCID: PMC10493260 DOI: 10.1016/j.xagr.2023.100257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023] Open
Abstract
INTRODUCTION Vaginal stenosis is a common complication following construction of a neovagina with vascularized myocutaneous flaps. This is primarily because of inconsistent or inappropriate vaginal dilator use. Image-guided recanalization, especially for obstructed genitourinary tracts, is an emerging idea in interventional radiology. Although multiple surgical techniques have been reported to treat vaginal agenesis or obstruction, the idea of image-guided recanalization of vaginal stenosis is a relatively new management strategy for vaginal stenosis. CASE We present a challenging case of a patient who initially presented with the complaint of increasing pelvic pressure after the creation of a neovagina via vaginoplasty. She had a distal neovagina created after extensive surgical resection for a large infiltrating pelvic rectal adenocarcinoma. A computed tomography scan revealed a fluid-filled neovaginal abscess. Examination under anesthesia revealed complete stenosis of the neovagina with no identifiable tract for dilation. INTERVENTION A computed tomography scan and fluoroscopy-guided sharp recanalization of the stenosed neovagina was performed, followed by serial fluoroscopic balloon angioplasty to dilate the stenosed neovagina. Finally, the patient underwent a gynecologic surgery for the excision of remaining granulation tissue to produce a more permanent patent neovagina, followed by regular and proper use of vaginal dilators to ensure patency. CONCLUSION This case report demonstrates that image-guided techniques can be used to aid in vaginal recanalization in the postoperative setting.
Collapse
Affiliation(s)
- Aliza Mushtaq
- Department of Radiology, Mayo Clinic, Rochester, MN (Drs Mushtaq, Woodrum, Thompson, Bjarnason, and Bendel)
| | - David A. Woodrum
- Department of Radiology, Mayo Clinic, Rochester, MN (Drs Mushtaq, Woodrum, Thompson, Bjarnason, and Bendel)
| | - Scott M. Thompson
- Department of Radiology, Mayo Clinic, Rochester, MN (Drs Mushtaq, Woodrum, Thompson, Bjarnason, and Bendel)
| | - Haraldur Bjarnason
- Department of Radiology, Mayo Clinic, Rochester, MN (Drs Mushtaq, Woodrum, Thompson, Bjarnason, and Bendel)
| | - Emily Bendel
- Department of Radiology, Mayo Clinic, Rochester, MN (Drs Mushtaq, Woodrum, Thompson, Bjarnason, and Bendel)
| | | | - Carrie L. Langstraat
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN (Dr Langstraat)
| |
Collapse
|
3
|
Kling JM, Saadedine M, Faubion SS, Kapoor E. Sexual Health Update in Women. J Womens Health (Larchmt) 2023; 32:10-14. [PMID: 36413021 DOI: 10.1089/jwh.2022.0392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The Clinical Update series is intended to help busy clinicians stay up to date with recently published important and potentially practice-changing articles on topics pertinent to the care of women. In this update on sexual health, we review studies on use of vaginal dilators for vaginal stenosis in gynecologic cancer survivors, sexual dysfunction in transgender people, as well as studies evaluating the effect of physical activity and infertility on female sexual health.
Collapse
Affiliation(s)
- Juliana M Kling
- Division of Women's Health Internal Medicine, Mayo Clinic, Scottsdale, Arizona, USA.,Center for Women's Health, Mayo Clinic, Rochester, Minnesota, USA
| | - Mariam Saadedine
- Center for Women's Health, Mayo Clinic, Rochester, Minnesota, USA.,Division of General Internal Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Stephanie S Faubion
- Center for Women's Health, Mayo Clinic, Rochester, Minnesota, USA.,Division of General Internal Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Ekta Kapoor
- Center for Women's Health, Mayo Clinic, Rochester, Minnesota, USA.,Menopause and Women's Sexual Health Clinic, Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.,Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota, USA.,Women's Health Research Center, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
4
|
Eleje GU, Ihekwoaba EC, Onu OA, Igbodike EP, Ilokanuno CN, Chukwuanukwu TO, Okoro CC, Obioha KC, Okpala BC. Conception following successful repair of two previous failed attempts at repair of partial transverse vaginal septum diagnosed after marital union: A case report. SAGE Open Med Case Rep 2022; 10:2050313X221141532. [PMID: 36507061 PMCID: PMC9726837 DOI: 10.1177/2050313x221141532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 11/09/2022] [Indexed: 12/07/2022] Open
Abstract
Transverse vaginal septum is a congenital anomaly in which a membrane obstructs the vagina. This can be partial or complete in type. Although rare, it presents peculiar challenges in symptomatology, diagnosis, and ultimate management. To our knowledge, we are the first to report a shortest vaginoplasty-conception interval following successful repair of previously failed repair of partial transverse vaginal septum. A 28-year-old Nigerian married nulliparous lady who presented to us with history of inability of penile-vaginal penetration with the presence of normal menstrual flow after two previous failed attempts at repair. She had a vaginoplasty with placement of a vaginal mold to prevent stenosis. She was subsequently able to have successful sexual intercourse and achieved pregnancy after 2 months, without recurrence of vaginal stenosis. When transverse vaginal septum is encountered in a married nullipara, a thorough clinical evaluation of the viability and feasibility of a vaginoplasty should be made during the first surgery. If repeated failed repair occurs, as in our case, we recommend meticulous and experienced surgical attention from the outset. The originality in this report lies in the very short period between repair and successful conception. Thus, we obtained satisfactory short-term clinical outcome of successful conception at the 2 months follow-up.
Collapse
Affiliation(s)
- George Uchenna Eleje
- Effective Care Research Unit, Department of Obstetrics and Gynecology, Nnamdi Azikiwe University, Nnewi, Nigeria,Department of Obstetrics and Gynecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria,George Uchenna Eleje, Effective Care Research Unit, Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University, P.M.B. 5001, Nnewi, 435001, Nigeria. Emails: ;
| | - Eric Chukwudi Ihekwoaba
- Department of Surgery, Faculty of Medicine, Nnamdi Azikiwe University, Awka, Nigeria,Department of Surgery, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
| | - Onyekachi Amos Onu
- Department of Surgery, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
| | - Emeka Philip Igbodike
- Department of Obstetrics and Gynecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
| | - Chinedu Nnaemeka Ilokanuno
- Plastic and Reconstructive Surgery Unit, Department of Surgery, Nnamdi Azikiwe University, Awka, Nigeria,Plastic and Reconstructive Surgery Unit, Department of Surgery, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
| | - Titus Osita Chukwuanukwu
- Plastic and Reconstructive Surgery Unit, Department of Surgery, Nnamdi Azikiwe University, Awka, Nigeria,Plastic and Reconstructive Surgery Unit, Department of Surgery, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
| | | | - Kingsley Chukwu Obioha
- Department of Obstetrics and Gynecology, University of Nigeria Teaching Hospital, Ituku Ozalla, Nigeria
| | - Boniface Chukwuneme Okpala
- Effective Care Research Unit, Department of Obstetrics and Gynecology, Nnamdi Azikiwe University, Nnewi, Nigeria,Department of Obstetrics and Gynecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
| |
Collapse
|
5
|
Wang J, Zhang KS, Liu Z, Wang T, Wang RH, Zhang FQ, Yu L, Wang YL, Wei LC, Shi M, Li S, Liu BG, Shi F, Su J, Yuan W, Zhang QY, Zhang J. Using New Vaginal Doses Evaluation System to Assess the Dose-Effect Relationship for Vaginal Stenosis After Definitive Radio(Chemo)Therapy for Cervical Cancer. Front Oncol 2022; 12:840144. [PMID: 35515128 PMCID: PMC9063038 DOI: 10.3389/fonc.2022.840144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 03/21/2022] [Indexed: 11/13/2022] Open
Abstract
Objective The study aims to investigate if a relationship exists between vaginal doses and vaginal stenosis (VS) using posterior-inferior border of symphysis (PIBS) points and the International Commission on Radiation Units-Rectum (ICRU-R) point evaluation system for definitive radio(chemo)therapy in locally advanced cervical cancer. Methods and Materials From a vaginal dose study in China, 351 patients were prospectively assessed. For every reference point of the PIBS system and ICRU-R point was calculated for all BT and summed with EBRT. Pearson's chi-square test and Student's unpaired t-test compared variables with and without vaginal stenosis (VS) G ≥2. The risk factors were assessed for VS G ≥2 in multi- and univariate analyses through Cox proportional hazards model followed by a dose-effect curve construction. The VS morbidity rate was compared via the log-rank test using the median vaginal reference length (VRL). Results The patients (38-month median follow-up) had 21.3% three-year actuarial estimate for VS G ≥2. Compared to G <2 patients, VS G ≥2 patients received higher doses to PIBS points except for PIBS - 2 and had significantly shorter VRL. VRL (HR = 1.765, P = 0.038), total EBRT and BT ICRU-R point dose (HR = 1.017, p = 0.003) were risk factors for VS. With VRL >4.6 cm, the 3-year actuarial estimate was 12.8% vs. 29.6% for VRL ≤4.6 cm. According to the model curve, the risks were 21, 30, and 39% at 75, 85, and 95 Gy, respectively (ICRU-R point dose). Conclusions PIBS system point doses correlated with late vaginal toxicity. VRL combined with both EBRT and BT dose to the ICRU-R point contribute to VS risk.
Collapse
Affiliation(s)
- Juan Wang
- Department of Radiation Oncology, The First Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, China
| | - Kai-Shuo Zhang
- Department of Radiation Oncology, Hanzhong Center Hospital, Hanzhong, China
| | - Zi Liu
- Department of Radiation Oncology, The First Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, China
| | - Tao Wang
- Department of Radiation Oncology, The First Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, China
| | - Rui-Hua Wang
- Department of Radiation Oncology, The First Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, China
| | - Fu-Quan Zhang
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lang Yu
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ya-Li Wang
- Department of Radiation Oncology, The Second Affiliated hospital of Xi'an Jiao Tong University, Xi'an, China
| | - Li-Chun Wei
- Department of Radiation Oncology, First Affiliated Hospital of Air Force Medical University, Xi'an, China
| | - Mei Shi
- Department of Radiation Oncology, First Affiliated Hospital of Air Force Medical University, Xi'an, China
| | - Sha Li
- Department of Radiation Oncology, The 940th Hospital of Joint Logistics Support force of Chinese People's Liberation Army, Lanzhou, China
| | - Bao-Gang Liu
- Department of Radiation Oncology, The Second Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, China
| | - Fan Shi
- Department of Radiation Oncology, The First Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, China
| | - Jin Su
- Department of Radiation Oncology, The First Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, China
| | - Wei Yuan
- Department of Radiation Oncology, The First Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, China
| | - Qi Ying Zhang
- Department of Radiation Oncology, The First Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, China
| | - Jing Zhang
- Department of Radiation Oncology, The First Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, China
| |
Collapse
|
6
|
Charatsi D, Vanakara P, Evaggelopoulou E, Simopoulou F, Korfias D, Daponte A, Kyrgias G, Tolia M. Vaginal dilator use to promote sexual wellbeing after radiotherapy in gynecological cancer survivors. Medicine (Baltimore) 2022; 101:e28705. [PMID: 35089231 PMCID: PMC8797530 DOI: 10.1097/md.0000000000028705] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 01/06/2022] [Indexed: 01/05/2023] Open
Abstract
This study investigated the efficacy of a vaginal dilator (VD) for the treatment of radiation-induced vaginal stenosis (VS) and the effect of a VD on sexual quality of life.Fifty three patients with endometrial or cervical cancers participated in this prospective observational study. All participants were treated with radical or adjuvant external beam radiotherapy and/or brachytherapy. They were routinely examined 4 times after radiotherapy (RT) and were also asked to complete a validated sexual function-vaginal changes questionnaire. SPSS version 20 and Minitab version 16 were used for the statistical analysis. The statistical significance was set at P < .05.The VS grading score decreased and the comfortably insertable VD size gradually increased throughout a year of VD use; all patients with initial grade 3 showed a VS of grade 2 after 12 months of VD use and 65.8% of the patients with initial grade 2 demonstrated a final VS of grade 1, while 77.8% of the participants who started with the first size of VD reached the third size after 12 months. Starting VD therapy ≤3 months after the end of RT was associated with a significant decrease in VS. A total of 60.9% of participants reported that they did not feel their vaginas were too small during intercourse after 12 months of dilation, whereas only 11.5% gave the same answer before starting dilation. Furthermore, 47.17% rated their satisfaction with their sexual life 5 out of 7 and only 3.77% gave a score of 3 after 12 months of dilation.Endometrial and cervical cancer survivors are encouraged to use VD to treat VS and for sexual rehabilitation after RT. This study recommends starting vaginal dilation no more than 3 months after treatment at least 2 to 3 times a week for 10 to 15 minutes over 12 months. However, larger, well-designed randomized clinical trials should be conducted to develop specific guidelines for VD use and efficacy in VS and sexual sexual quality of life after RT.
Collapse
Affiliation(s)
- Dimitra Charatsi
- School of Health Sciences, Faculty of Medicine, University of Thessaly, Biopolis, Larissa, Greece
| | - Polyxeni Vanakara
- Department of Obstetrics and Gynecology, University Hospital of Larissa, Larissa, Greece
| | | | - Foteini Simopoulou
- Department of Radiation Oncology, Iaso Thessaly Hospital, Larissa, Greece
| | - Dimitrios Korfias
- Department of Gynecology, Metaxa Cancer Hospital, Mpotasi 51, Piraeus, Greece
| | - Alexandros Daponte
- School of Health Sciences, Faculty of Medicine, University of Thessaly, Biopolis, Larissa, Greece
- Department of Obstetrics and Gynecology, University Hospital of Larissa, Larissa, Greece
| | - George Kyrgias
- School of Health Sciences, Faculty of Medicine, University of Thessaly, Biopolis, Larissa, Greece
- Department of Radiation Oncology, University Hospital of Larissa, Larissa, Greece
| | - Maria Tolia
- Radiotherapy Department, Faculty of Medicine, School of Health Sciences, University of Crete, University Hospital of Heraklion, Heraklion, Crete, Greece
| |
Collapse
|
7
|
Mishra N, Singh N, Sachdeva M, Ghatage P. Sexual Dysfunction in Cervical Cancer Survivors: A Scoping Review. Womens Health Rep (New Rochelle) 2021; 2:594-607. [PMID: 35141708 PMCID: PMC8820405 DOI: 10.1089/whr.2021.0035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/15/2021] [Indexed: 06/14/2023]
Abstract
Sexual function in cervical cancer survivors declines significantly after treatments irrespective of the modality used. Only a few studies have looked at their psychosexual needs, perception, and acceptance of psychosexual support. This review summarizes findings of current qualitative as well as quantitative studies to understand the plight of cervical cancer survivors regarding sexual dysfunction and the management issues. The effect of gynecologic cancers on sexuality depends on multiple factors such as psychosexual factors, biologic factors, and age. Younger patients have poorer outcomes with a more pronounced impact on sexual well-being. Radicality of surgery has direct correlation with sexual dysfunction. Low or no sexual interest, lack of lubrication, dyspareunia, and reduced vaginal caliber are frequently found. For too long, researchers have focused on defining the prevalence and types of sexual problems after various cancer treatments. The area that continues to be neglected is the evaluation of effective interventions to prevent or treat cancer-related sexual dysfunction. In particular, mental health and medical specialists need to collaborate to create cost-effective treatment programs. Collaborative intervention with gynecologists, sexologists, radiotherapists, and nursing staff would be beneficial to optimize the sexual wellness of cancer survivors and their spouses.
Collapse
Affiliation(s)
- Neha Mishra
- Department of Obstetrics and Gynaecology, GIMS, Greater Noida, India
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Nilanchali Singh
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
- Department of Gynaecologic Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada
| | - Mohini Sachdeva
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Prafull Ghatage
- Department of Gynaecologic Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
8
|
Kanneganti A, Ismail-Pratt I, Yasin N, Low JJH. Surgical management of recurrent vaginal obliteration due to severe erosive lichen planus. Int J Gynaecol Obstet 2021; 154:368-369. [PMID: 34013977 DOI: 10.1002/ijgo.13762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 05/18/2021] [Indexed: 11/06/2022]
Affiliation(s)
- Abhiram Kanneganti
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore
| | | | - Nooraishah Yasin
- Department of Gynaecology Oncology, Gold Coast University Hospital, Gold Coast, QLD, Australia
| | - Jeffrey J H Low
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore.,Division of Gynaecologic Oncology, National University Cancer Institute, Singapore
| |
Collapse
|
9
|
Varytė G, Bartkevičienė D. Pelvic Radiation Therapy Induced Vaginal Stenosis: A Review of Current Modalities and Recent Treatment Advances. ACTA ACUST UNITED AC 2021; 57:336. [PMID: 33915994 DOI: 10.3390/medicina57040336] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 03/26/2021] [Accepted: 03/29/2021] [Indexed: 12/03/2022]
Abstract
Radiation-induced vaginal stenosis (VS) is a common side effect of pelvic radiotherapy (RT). RT-induced VS may have various negative effects on women’s quality of life, in particular dyspareunia, decreased vaginal lubrication and difficulties in sexual intercourse. This narrative review provides the aspects of RT-induced VS pathogenesis, incidence, evaluation and associated risk factors. Available treatment modalities are discussed in the article, putting the focus on preliminary, although promising, experience in the use of hyaluronic acid and laser therapy in cancer survivors after pelvic RT.
Collapse
|
10
|
Abstract
AIM Stress urinary incontinence (SUI) is a common benign disease causing a markedly negative impact on quality of life. Vaginal laser is a minimally invasive treatment and no major complications of this technique have been published to date. The purpose of the article is to present the first major adverse event related to this treatment. MATERIALS AND METHODS We present the case of a 48-year-old woman with an important complication after vaginal laser for SUI. RESULTS The patient presented a transverse vaginal septum and shortening of vaginal length after two sessions of vaginal erbium:yttrium aluminum garnet laser treatment. She required two surgical interventions, local injections, and pelvic floor physiotherapy, although currently the patient has not experienced complete resolution of symptoms. DISCUSSION AND CONCLUSIONS Vaginal laser use can lead to serious adverse events. Selection of patients and treatment must be carried out with caution.
Collapse
Affiliation(s)
- A Cañadas Molina
- Department of Gynecology and Obstetrics, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - R Sanz Baro
- Department of Gynecology and Obstetrics, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| |
Collapse
|
11
|
Autorino R, Tagliaferri L, Campitelli M, Smaniotto D, Nardangeli A, Mattiucci GC, Macchia G, Gui B, Miccò M, Mascilini F, Ferrandina G, Kovacs G, Valentini V, Gambacorta MA. EROS study: evaluation between high-dose-rate and low-dose-rate vaginal interventional radiotherapy (brachytherapy) in terms of overall survival and rate of stenosis. J Contemp Brachytherapy 2018; 10:315-20. [PMID: 30237815 DOI: 10.5114/jcb.2018.77953] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 07/11/2018] [Indexed: 11/29/2022] Open
Abstract
Purpose To compare the survival and toxicity outcomes in patients with endometrial cancer treated with either high-dose-rate (HDR) or low-dose-rate (LDR) vaginal brachytherapy (VBT) following external beam radiotherapy (EBRT). Material and methods From January 2000 to December 2014, patients with endometrial cancer after radical hysterectomy with/without pelvic and/or para-aortic lymphadenectomy were treated with adjuvant EBRT (45 Gy, 1.8 Gy/day to the whole pelvis) and subsequent VBT boost (HDR dose of 7 Gy in one fraction or LDR VBT dose of 25 Gy). The dose was prescribed at 0.5 cm from the surface of the applicator and the proximal half to two-thirds of the vagina was irradiated. The outcomes of patients were evaluated in terms of local control (LC), overall survival (OS), and rates of adverse events. Results We analyzed data of 200 patients treated with EBRT followed by HDR VBT boost in 78 patients and LDR VBT boost in 122 patients. With a median follow-up of 25 months (range, 6-163), 5-year OS was 98% and 97% in the LDR and HDR groups, respectively (p = 0.37). The 5-year LC was similar (93% in both groups) (p = 0.81). In multivariate analyses, none of the factors assessed (age, stage, grade) impacted OS (p = 0.37) or LC (p = 0.81). Patients treated with LDR VBT after EBRT had higher rates of acute gastrointestinal toxicity. No differences were found in acute genitourinary or hematological toxicities. Late toxicity such as vaginal stenosis was registered during regular follow-up visits and was similar in the two groups (p = 0.67). Conclusions In our analysis, there were no differences in terms of OS and late toxicity outcomes for patients receiving LDR or HDR VBT. HDR VBT is a safe technique in comparison to LDR VBT.
Collapse
|
12
|
Abstract
Treatment of gynecological cancer commonly involves pelvic radiation therapy (RT) and/or brachytherapy. A commonly observed side effect of such treatment is radiation-induced vaginal stenosis (VS). This review analyzed the incidence, pathogenesis, clinical manifestation(s) and assessment and grading of radiation-induced VS. In addition, risk factors, prevention and treatment options and follow-up schedules are also discussed. The limited available literature on many of these aspects suggests that additional studies are required to more precisely determine the best management strategy of this prevalent group after RT.
Collapse
Affiliation(s)
- Lucinda Morris
- Crown Princess Mary Cancer Centre Westmead, Radiation Oncology Network, Westmead
| | - Viet Do
- Crown Princess Mary Cancer Centre Westmead, Radiation Oncology Network, Westmead
| | - Jennifer Chard
- Crown Princess Mary Cancer Centre Westmead, Radiation Oncology Network, Westmead
| | - Alison H Brand
- Discipline of Obstetrics, Gynaecology and Neonatology, Westmead Clinical School, University of Sydney, Camperdown
- Department of Gynaecological Oncology, Westmead Hospital, Westmead, NSW, Australia
| |
Collapse
|
13
|
Koyama-Sato M, Hashida O, Nakamura T, Hirahara F, Sakakibara H. Case of early postoperative adhesion in a patient with molimina due to transverse vaginal septum concomitant with imperforate hymen. J Obstet Gynaecol Res 2015; 41:1141-4. [PMID: 25771822 DOI: 10.1111/jog.12669] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 11/21/2014] [Indexed: 11/30/2022]
Abstract
Transverse vaginal septum is a residual vaginal plate composed of the Müllerian duct and urogenital sinus. Imperforate hymen results from failure of perforation of the membrane between the urogenital sinus and vaginal cavity. We report a rare case of concurrence of these two conditions. A 16-year-old girl had been treated with puncture several times for hematometra and hematocolpos from 13 years of age because of monthly occurrence of lower abdominal pain without menstrual bleeding and was referred to our hospital. Magnetic resonance imaging demonstrated hematometra, hematocolpos and expansion of the vaginal fornix. The imperforate hymen was incised and a slight adhesion at the lower vaginal cavity was detached. After that, a complete transverse vaginal septum, which was 5 mm thick, was identified. It was excised after ultrasonography-guided puncture. Although two cycles of menstrual bleeding took place, molimina recurred. Re-operation was performed 6 months after the first operation, and recurrence of adhesion in the lower vaginal cavity was identified. A silicon dilator was inserted, but she could not use it at home and instead used a tampon. Cyclic menstrual bleeding is observed 4 months after the second operation.
Collapse
Affiliation(s)
- Makiko Koyama-Sato
- Department of Obstetrics and Gynecology, Yokohama City University, Yokohama City, Japan
| | - Osamu Hashida
- Department of Obstetrics and Gynecology, Yokohama City University, Yokohama City, Japan
| | - Tomomi Nakamura
- Department of Obstetrics and Gynecology, Yokohama City University, Yokohama City, Japan
| | - Fumiki Hirahara
- Department of Obstetrics and Gynecology, Yokohama City University, Yokohama City, Japan
| | - Hideya Sakakibara
- Department of Obstetrics and Gynecology, Yokohama City University, Yokohama City, Japan
| |
Collapse
|
14
|
Patwardhan SK, Sawant A, Ismail M, Nagabhushana M, Varma RR. Simultaneous bladder and vaginal reconstruction using ileum in complicated vesicovaginal fistula. Indian J Urol 2011; 24:348-51. [PMID: 19468466 PMCID: PMC2684342 DOI: 10.4103/0970-1591.39546] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To discuss the outcome of surgical repair in complicated vesicovaginal fistula with simultaneous bladder and vaginal reconstruction using ileum. MATERIALS AND METHODS Four female patients in the age group of 12-30 years are included. All the patients had complicated vesicovaginal fistula with vaginal stenosis secondary to obstetric hysterectomy (except one secondary to the genitourinary tuberculosis). Repair of vesicovaginal fistula with simultaneous bladder augmentation, ureteric reimplantation, and reconstruction of vagina using ileum was performed in all the cases. RESULTS All the patients had successful repair of fistula. Vaginal reconstruction using ileum, resulted in capacious vagina. Adult patients resumed to normal sexual life. Mucus discharge was the only complaint in postoperative period. CONCLUSIONS Malnutrition, anemia, obstructed labor, Intra uterine fetal death (IUFD), postpartum hemorrhage following forceps delivery in a rural setting followed by an emergency obstetric hysterectomy after a delay of 6-8 h (due to transfer to a tertiary center) were the few contributing factors leading to the formation of vesicovaginal fistula (VVF). Preoperative assessment of bladder capacity and vaginal capacity in such cases is mandatory. The small bowel is a readily available vascular tissue for restoring bladder and vaginal capacity.
Collapse
|