Curriculum Vitae
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Obliterative Lefort Colpocleisis in a Large Group of Elderly Women
Obliterative LeFort Colpocleisis in a Large Group of Elderly Women Salomon Zebede, MD, Aimee L. Smith, MD, Leon N. Plowright, MD, Aparna Hegde, MD, Vivian C. Aguilar, MD, and G. Willy Davila, MD OBJECTIVE: To report on anatomical and functional satisfaction. Associated morbidity and mortality related outcomes, patient satisfaction, and associated morbidity to the procedure are low. Colpocleisis remains an and mortality in patients undergoing LeFort colpocleisis. excellent surgical option for the elderly patient with METHODS: This was a retrospective case series of advanced pelvic organ prolapse. LeFort colpocleisis performed from January 2000 to (Obstet Gynecol 2013;121:279–84) October 2011. Data obtained from a urogynecologic DOI: http://10.1097/AOG.0b013e31827d8fdb database included demographics, comorbidities, medi- LEVEL OF EVIDENCE: III cations, and urinary and bowel symptoms. Prolapse was quantified using the pelvic organ prolapse quantification y 2050, the elderly will represent the largest section (POP-Q) examination. Operative characteristics were Bof the population and pelvic floor dysfunction is recorded. All patients underwent pelvic examination projected to affect 58.2 million women in the United and POP-Q assessment at follow-up visits. Patients also States. We thus can expect to see a increase in the were asked about urinary and bowel symptoms as well as demand for urogynecologic services in this popula- overall satisfaction. All intraoperative and postoperative tion.1,2 Most women older than age 65 years are surgical complications were recorded. afflicted with at least one chronic medical condition, RESULTS: Three hundred twenty-five patients under- and, with the rate of comorbid conditions increasing went LeFort colpocleisis. -
Colpocleisis (Closing the Vagina to Treat Prolapse)
Colpocleisis (Closing the vagina to treat prolapse) Patient Information Leaflet About this leaflet The information provided in this leaflet should be used as a guide. There may be some variation in how each gynaecologist performs the procedure, the care procedures on the ward immediately after your operation and the advice given to you when you get home. You should ask your gynaecologist about any concerns that you may have. You should take your time to read this leaflet. A page is provided at the end of the leaflet for you to write down any questions you may have. It is your right to know about your planned operation/procedure, why it has been recommended, what the alternatives are and what the risks and benefits are. These should be covered in this leaflet. You may also wish to ask about your gynaecologist’s personal experience and results of treating your condition. Benefits and risks The success and the risks of most operations carried out to treat prolapse and incontinence have been poorly studied and so it is often not possible to define them clearly. In this leaflet risks may be referred to as common, rare etc. or an approximate level of risk may be given. Further information about risk is explained in a leaflet published by the Royal College of Obstetricians and Gynaecologists “Understanding how risk is discussed in healthcare”. https://www.rcog.org.uk/globalassets/documents/patients/patient-information-leaflets/pi- understanding-risk.pdf The following table is taken from that leaflet British Society of Urogynaecology (BSUG) database In order to better understand the success and risks of surgery for prolapse and incontinence the British Society of Urogynaecology has established a national database. -
Overview of Surgical Techniques in Gender-Affirming Genital Surgery
208 Review Article Overview of surgical techniques in gender-affirming genital surgery Mang L. Chen1, Polina Reyblat2, Melissa M. Poh2, Amanda C. Chi2 1GU Recon, Los Angeles, CA, USA; 2Southern California Permanente Medical Group, Los Angeles, CA, USA Contributions: (I) Conception and design: ML Chen, AC Chi; (II) Administrative support: None; (III) Provision of study materials or patients: All authors; (IV) Collection and assembly of data: None; (V) Data analysis and interpretation: None; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Correspondence to: Amanda C. Chi. 6041 Cadillac Ave, Los Angeles, CA 90034, USA. Email: [email protected]. Abstract: Gender related genitourinary surgeries are vitally important in the management of gender dysphoria. Vaginoplasty, metoidioplasty, phalloplasty and their associated surgeries help patients achieve their main goal of aligning their body and mind. These surgeries warrant careful adherence to reconstructive surgical principles as many patients can require corrective surgeries from complications that arise. Peri- operative assessment, the surgical techniques employed for vaginoplasty, phalloplasty, metoidioplasty, and their associated procedures are described. The general reconstructive principles for managing complications including urethroplasty to correct urethral bulging, vaginl stenosis, clitoroplasty and labiaplasty after primary vaginoplasty, and urethroplasty for strictures and fistulas, neophallus and neoscrotal reconstruction after phalloplasty are outlined as well. Keywords: Transgender; vaginoplasty; phalloplasty; metoidioplasty Submitted May 30, 2019. Accepted for publication Jun 20, 2019. doi: 10.21037/tau.2019.06.19 View this article at: http://dx.doi.org/10.21037/tau.2019.06.19 Introduction the rectum and the lower urinary tract, formation of perineogenital complex for patients who desire a functional The rise in social awareness of gender dysphoria has led vaginal canal, labiaplasty, and clitoroplasty. -
OBGYN-Study-Guide-1.Pdf
OBSTETRICS PREGNANCY Physiology of Pregnancy: • CO input increases 30-50% (max 20-24 weeks) (mostly due to increase in stroke volume) • SVR anD arterial bp Decreases (likely due to increase in progesterone) o decrease in systolic blood pressure of 5 to 10 mm Hg and in diastolic blood pressure of 10 to 15 mm Hg that nadirs at week 24. • Increase tiDal volume 30-40% and total lung capacity decrease by 5% due to diaphragm • IncreaseD reD blooD cell mass • GI: nausea – due to elevations in estrogen, progesterone, hCG (resolve by 14-16 weeks) • Stomach – prolonged gastric emptying times and decreased GE sphincter tone à reflux • Kidneys increase in size anD ureters dilate during pregnancy à increaseD pyelonephritis • GFR increases by 50% in early pregnancy anD is maintaineD, RAAS increases = increase alDosterone, but no increaseD soDium bc GFR is also increaseD • RBC volume increases by 20-30%, plasma volume increases by 50% à decreased crit (dilutional anemia) • Labor can cause WBC to rise over 20 million • Pregnancy = hypercoagulable state (increase in fibrinogen anD factors VII-X); clotting and bleeding times do not change • Pregnancy = hyperestrogenic state • hCG double 48 hours during early pregnancy and reach peak at 10-12 weeks, decline to reach stead stage after week 15 • placenta produces hCG which maintains corpus luteum in early pregnancy • corpus luteum produces progesterone which maintains enDometrium • increaseD prolactin during pregnancy • elevation in T3 and T4, slight Decrease in TSH early on, but overall euthyroiD state • linea nigra, perineum, anD face skin (melasma) changes • increase carpal tunnel (median nerve compression) • increased caloric need 300cal/day during pregnancy and 500 during breastfeeding • shoulD gain 20-30 lb • increaseD caloric requirements: protein, iron, folate, calcium, other vitamins anD minerals Testing: In a patient with irregular menstrual cycles or unknown date of last menstruation, the last Date of intercourse shoulD be useD as the marker for repeating a urine pregnancy test. -
UNMH Obstetrics and Gynecology Clinical Privileges Name
UNMH Obstetrics and Gynecology Clinical Privileges Name:____________________________ Effective Dates: From __________ To ___________ All new applicants must meet the following requirements as approved by the UNMH Board of Trustees, effective April 28, 2017: Initial Privileges (initial appointment) Renewal of Privileges (reappointment) Expansion of Privileges (modification) INSTRUCTIONS: Applicant: Check off the “requested” box for each privilege requested. Applicants have the burden of producing information deemed adequate by the Hospital for a proper evaluation of current competence, current clinical activity, and other qualifications and for resolving any doubts related to qualifications for requested privileges. Department Chair: Check the appropriate box for recommendation on the last page of this form. If recommended with conditions or not recommended, provide condition or explanation. OTHER REQUIREMENTS: 1. Note that privileges granted may only be exercised at UNM Hospitals and clinics that have the appropriate equipment, license, beds, staff, and other support required to provide the services defined in this document. Site-specific services may be defined in hospital or department policy. 2. This document defines qualifications to exercise clinical privileges. The applicant must also adhere to any additional organizational, regulatory, or accreditation requirements that the organization is obligated to meet. --------------------------------------------------------------------------------------------------------------------------------------- -
SJH Procedures
SJH Procedures - Gynecology and Gynecology Oncology Services New Name Old Name CPT Code Service ABLATION, LESION, CERVIX AND VULVA, USING CO2 LASER LASER VAPORIZATION CERVIX/VULVA W CO2 LASER 56501 Destruction of lesion(s), vulva; simple (eg, laser surgery, Gynecology electrosurgery, cryosurgery, chemosurgery) 56515 Destruction of lesion(s), vulva; extensive (eg, laser surgery, Gynecology electrosurgery, cryosurgery, chemosurgery) 57513 Cautery of cervix; laser ablation Gynecology BIOPSY OR EXCISION, LESION, FACE AND NECK EXCISION/BIOPSY (MASS/LESION/LIPOMA/CYST) FACE/NECK General, Gynecology, Plastics, ENT, Maxillofacial BIOPSY OR EXCISION, LESION, FACE AND NECK, 2 OR MORE EXCISE/BIOPSY (MASS/LESION/LIPOMA/CYST) MULTIPLE FACE/NECK 11102 Tangential biopsy of skin (eg, shave, scoop, saucerize, curette); General, Gynecology, single lesion Aesthetics, Urology, Maxillofacial, ENT, Thoracic, Vascular, Cardiovascular, Plastics, Orthopedics 11103 Tangential biopsy of skin (eg, shave, scoop, saucerize, curette); General, Gynecology, each separate/additional lesion (list separately in addition to Aesthetics, Urology, code for primary procedure) Maxillofacial, ENT, Thoracic, Vascular, Cardiovascular, Plastics, Orthopedics 11104 Punch biopsy of skin (including simple closure, when General, Gynecology, performed); single lesion Aesthetics, Urology, Maxillofacial, ENT, Thoracic, Vascular, Cardiovascular, Plastics, Orthopedics 11105 Punch biopsy of skin (including simple closure, when General, Gynecology, performed); each separate/additional lesion -
Obliterating the Vaginal Canal to Correct Pelvic Organ Prolapse
Surgical TechniQueS Step by step: Obliterating the vaginal canal to correct pelvic organ prolapse Very elderly age, comorbidity, and disinterest in maintaining sexual function make a woman an ideal candidate for having POP corrected by surgery to close the vaginal canal, detailed here Mickey Karram, MD, and Janelle evans, MD s women live longer, on average, pel- for them less than an ideal solution. vic floor disorders are, as a whole, be- Instead, surgical procedures that obliter- A coming more prevalent and a greater ate the vaginal canal can alleviate their health and social problem. Many women symptoms of POP. entering the eighth and ninth decades of life In this article, we provide a step-by-step display symptomatic pelvic organ prolapse description of: In thIs (POP)—often after an unsuccessful trial of a • leFort partial colpocleisis in a woman Article pessary or even surgery. who still has her uterus in place Total colpectomy These elderly patients often have other • partial or complete colpectomy and and colpocleisis concomitant medical issues and are not colpocleisis in a woman who has post- page 32 sexually active, making extensive surgery hysterectomy prolapse • levator plication and perineorrhaphy, as es- sential concluding steps in these procedures. Distal levatoroplasty Dr. Karram is Director of the and perineorrhaphy Fellowship Program in Female Pelvic page 35 Medicine and Reconstructive Pelvic Surgery, University of Cincinnati/The leFort partial colpocleisis Christ Hospital, Cincinnati, Ohio; Co-Editor in Chief of the International An obliterative procedure in the form of a Questions about Academy of Pelvic Surgery (IAPS); LeFort partial colpocleisis is an option when outcomes and and Course Director of the Pelvic a patient 1) has her uterus and 2) is no lon- Anatomy and Gynecologic Surgery Symposium complications (PAGS) and the Female Urology and Urogynecology ger sexually active. -
1874-2203/21 Send Orders for Reprints to [email protected]
1874-2203/21 Send Orders for Reprints to [email protected] 8 Open Medicine Journal Content list available at: https://openmedicinejournal.com CASE REPORT Urinary Retention Secondary to Colpocleisis: A Case Report Elena Soto-Vega1, Yunam Cuan-Baltazar1, Arturo García-Mora2 and Carlos Arroyo1,3,* 1Escuela de medicina, Universidad Anáhuac Puebla, Av Kepler 2143-765, Col. Reserva Territorial Atlixcayotl, Puebla, C.P 72810, México 2Servicio de Urología, Hospital Médica Sur, Mexico City, Mexico 3Servicio de Urología, Hospital Ángeles de Puebla, Puebla, Mexico Abstract: Introduction: Pelvic Organ Prolapse (POP) is common in older women, and depending on its extent, it is conservative or surgically treated. Colpocleisis is a technique for POP treatment, in which the vaginal canal is closed, entirely or partially, in order to avoid the protrusion of the pelvic structures, with preservation of the urethral meatus in order to preserve normal micturition. Clinical Case: We present a case of a 61-year old woman, who 8 years after a colpocleisis, progressed to urinary retention associated with the progressive scarring of the labia, causing the obstruction of the urethral meatus. The patient underwent a labiaplasty with anterior colpoperineoplasty, with complete normalization of her micturition and sexual activity. Conclusion: Long term urinary retention complication has not been previously reported in the literature and should be included as a possible adverse event after colpocleisis. Keywords: Pelvic organ prolapse, Colpocleisis, Urinary -
Surgery for Pelvic Organ Prolapse
Committee 15 Surgery for Pelvic Organ Prolapse Chairman L. BRUBAKER (USA) Members C. GLAZENER (U.K), B. JACQUETIN (France), C. MAHER (Australia), A. MELGREM (USA), P. N ORTON (USA), N. RAJAMAHESWARI (India), P. V ON THEOBALD (France) 1273 CONTENTS INTRODUCTION IV. CONCOMITANT SURGERY 1. EFFECT OF COMBINATION PROCEDURES I. OUTCOME ASSESSMENT 2. HYSTERECTOMY - The Role of Hysterectomy in Surgical Treatment of 1. OUTCOME ASSESSMENT: ANATOMY Prolapse 2. OUTCOME ASSESSMENT: SYMPTOMS 3. CONTINENCE TREATMENT 3. OUTCOME EVALUATION: QUALITY OF LIFE (Treatment and Prophylaxis) 4. CONCOMITANT PERIOPERATIVE PELVIC II. SELECTION OF SURGICAL ROUTE PHYSICAL THERAPY FOR RECONSTRUCTIVE POP PROCEDURES V. THE ROLE OF AUGMENTING MATERIALS IN POP SURGERY 1. COMPARISON OF OPEN ABDOMINAL TO VAGINAL 1. AUGMENTATION FOR ANTERIOR WALL SURGERY 2. SAFETY ISSUES RELATED TO THE CHOICE OF SURGICAL ROUTE VI. RECTAL PROLAPSE 3. LAPAROSCOPIC AND ROBOTIC SURGERY 1. PERINEAL PROCEDURES III. EFFICACY OF SPECIFIC 2. TRANSABDOMINAL PROCEDURES PROCEDURES VII. RECOMMENDATIONS 1. RECONSTRUCTIVE PROCEDURES 2. OBLITERATIVE PROCEDURES: LeFort colpocleisis, Colpectomy and REFERENCES colpocleisis 1274 Surgery for Pelvic Organ Prolapse L. BRUBAKER, C. GLAZENER, B. JACQUETIN, C. MAHER, A. MELGREM, P. NORTON, N. RAJAMAHESWARI, P. VON THEOBALD Despite the need for additional studies to guide many INTRODUCTION aspects of POP surgical care, this chapter can be used to facilitate evidence-based management of Surgery for pelvic organ prolapse (POP) is common POP. This committee has deliberated, graded evidence with increasing high-quality evidence to guide surgical and provided recommended areas of high priority for practice. Yet many important basic questions remain, current surgical care as well as further POP research. including the optimal timing for POP surgery, the Readers of this chapter are also encouraged to optimal pre-operative evaluation of urinary tract periodically review continuously updated evidence function and the post-operative outcome assessment. -
Short and Long-Term Outcomes of the Manchester Procedure for Pelvic Organ Prolapse and the Impact of Major Levator Ani Muscle Defects
Short and long-term outcomes of the Manchester Procedure for Pelvic Organ Prolapse and the impact of major Levator Ani Muscle defects PhD thesis by Sissel Hegdahl Oversand, MD 2018 Department of Gynaecology, Oslo University Hospital, Ullevål and University of Oslo, Faculty of Medicine, Norway © Sissel Hegdahl Oversand, 2018 Series of dissertations submitted to the Faculty of Medicine, University of Oslo ISBN 978-82-8377-335-4 All rights reserved. No part of this publication may be reproduced or transmitted, in any form or by any means, without permission. Cover: Hanne Baadsgaard Utigard. Print production: Reprosentralen, University of Oslo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
Joint Report on Terminology for Surgical Procedures to Treat Pelvic
AUGS-IUGA JOINT PUBLICATION Joint Report on Terminology for Surgical Procedures to Treat Pelvic Organ Prolapse Developed by the Joint Writing Group of the American Urogynecologic Society and the International Urogynecological Association. Individual contributors are noted in the acknowledgment section. 03/02/2020 on BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AWnYQp/IlQrHD3JfJeJsayAVVC6IBQr6djgLHr3m8XRMZF6k61FXizrL9aj3Mm1iL7ZA== by https://journals.lww.com/jpelvicsurgery from Downloaded meaningful data about specific procedures, standardized and Downloaded Abstract: Surgeries for pelvic organ prolapse (POP) are common, but widely accepted terminology must be adopted. Each term for a standardization of surgical terms is needed to improve the quality of in- given procedure must indicate to researchers, clinicians, and from vestigation and clinical care around these procedures. The American learners a specific and reliable minimal set of steps. The aim of https://journals.lww.com/jpelvicsurgery Urogynecologic Society and the International Urogynecologic Associ- this document is to propose a standardized terminology to de- ation convened a joint writing group consisting of 5 designees from scribe common surgeries for POP. each society to standardize terminology around common surgical terms in POP repair including the following: sacrocolpopexy (including sacral colpoperineopexy), sacrocervicopexy, uterosacral ligament suspension, sacrospinous ligament fixation, iliococcygeus fixation, uterine preserva- tion prolapse procedures or hysteropexy -
Relaxation of the Supporting Structures of the Female Pelvis
Relaxation of the Supporting Structures of the Female Pelvis DAVID H. NICHOLS, M.D. Professor of Obstetrics and Gynecology, School of Medicine, State University of New Yori< at Buffalo, Buffalo, New Yori<, and Head of the Department of Obstetrics and Gynecology, Buffalo General Hospital, Buffalo, New Yori< The purpose of this discussion is to share and Shoemaker (Fig 1). and notice that the va with you some thoughts about pelvic relaxation, gina in this instance has an almost vertical axis. its mysteries, some technical minutiae helpful in Is that then the goal we seek when we reposi identifying them and some of the surgical prob tion a misplaced vagina? Or is the vagina being lems involved. Thus, by looking at a number of displaced anteriorly by a full rectum, which was these diagnostic challenges, you may be stimu full at the time of death, as this illustration obvi lated to some diagnostic thinking in an office ously was from a cadaver dissection? setting. To resolve the issue, the vaginas of nulli Let me start with a few of the more decep parous young women can be lightly painted tively simple challenges in pelvic relaxation, the with a barium paste. This would not distort the goals we seek to achieve, and how to accom vagina but would render it radio-opaque. Lateral plish them. colpograms taken of these women demonstrate We have seen within my generation a re that the vagina does have an S-shaped curve examination of sexual thinking whereby aging with a horizontal inclination to the axis of the up persons presume to continue a reasonably per vagina (Fig 2) If we were to ask these nul comfortable and satisfactory coital relationship liparous patients to bear down, as by a Valsalva well into their senior years.