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Falcone T.,Gynecology and Womens Health Institute
Fertility and Sterility | Year: 2014

In this Views and Reviews contribution there are four articles that provide insight into the present and future applications of robot assisted surgery. The potential application of this technology in reproductive surgery, oncology, general gynecology and urology is an ongoing controversy. © 2014 American Society for Reproductive Medicine. Source


Solomon E.R.,Baystate Medical Center | Janssen K.,Cleveland Clinic | Janssen K.,University Utrecht | Krajewski C.M.,Magee Womens Hospital | Barber M.D.,Gynecology and Womens Health Institute
Female Pelvic Medicine and Reconstructive Surgery | Year: 2015

Objective This study aimed to assess the quality of Web sites that provide information on pelvic organ prolapse using validated quality measurement tools. Methods The Google search engine was used to perform a search of the following 4 terms: "pelvic organ prolapse," "dropped bladder," "cystocele," and "vaginal mesh." The DISCERN appraisal tool and JAMA benchmark criteria were used to determine the quality of health information of each Web site. Cohen κ was performed to determine interrater reliability between reviewers. Kruskal-Wallis and Wilcoxon rank sum tests were used to compare DISCERN scores and JAMA criteria among search terms. Results Interrater reliability between the two reviewers using DISCERN was κ = 0.71 [95% confidence interval (CI), 0.68-0.74] and using JAMA criteria was κ = 0.98 (95% CI, 0.74-1.0). On the basis of the DISCERN appraisal tool, the search term "vaginal mesh" had significantly lower Web site quality than "pelvic organ prolapse" and "cystocele," respectively [mean difference of DISCERN score, -14.65 (95% CI, -25.50 to 8.50, P < 0.0001) and -12.55 (95% CI, -24.00 to 7.00, P = 0.0007)]. "Dropped bladder" had significantly lower Web site quality compared to "pelvic organ prolapse" and "cystocele," respectively (mean difference of DISCERN score, -9.55 (95% CI, -20.00 to 3.00, P = 0.0098) and -7.80 (95% CI, -18.00 to 1.00, P = 0.0348). Using JAMA criteria, there were no statistically significant differences between Web sites. Conclusions Web sites queried under search terms "vaginal mesh" and "dropped bladder" are lower in quality compared with the Web sites found using the search terms "pelvic organ prolapse" and "cystocele." © 2015 Wolters Kluwer Health, Inc. Source


De Carvalho L.F.P.,Obstetrics and Gynecology and Womens Health Institute | De Carvalho L.F.P.,University of Sao Paulo | Abrao M.S.,University of Sao Paulo | Biscotti C.,Cleveland Clinic | And 5 more authors.
Journal of Molecular Histology | Year: 2013

Oxidative stress is associated with many disease states including gynecologic disease. This process can damage lipids, proteins and DNA. The present study highlights the role of oxidative stress induced DNA damage as measured by 8-hydroxy-2-deoxyguanosine in development of benign gynecological conditions (BGC). Our aim was to map the oxidative DNA damage on female reproductive organs and highlight the high amount found in a variety of benign gynecologic disorders. Seventeen biopsy specimens from female pelvic organs were divided in two groups: healthy organs tissue and BGC tissue. Healthy organs biopsy tissue included the cervix, tubes, uterus, peritoneum, and topic endometrium in secretory phase. Benign gynecological biopsy tissue included hydrosalpinges, leiomyoma, adenomyosis and tubal cysts. Immunohistochemical staining showed significantly higher levels of DNA damage between BGC and healthy organs [19.36 % (6.20; 32.51) vs. 4.61 % (0.63; 8.53); P < 0.0344]. Our results highlight the involvement of oxidative stress DNA damage in female benign pelvic disease. Hydrosalpinges, leiomyoma, and adenomyosis exhibit the highest amounts of oxidative DNA damage in the pelvic cavity. © 2012 Springer Science+Business Media Dordrecht. Source


Shaw J.,Cleveland Clinic | Tunitsky-Bitton E.,Cleveland Clinic | Barber M.D.,Cleveland Clinic | Jelovsek J.E.,Cleveland Clinic | Jelovsek J.E.,Gynecology and Womens Health Institute
International Urogynecology Journal and Pelvic Floor Dysfunction | Year: 2014

Introduction and hypothesis: We describe the presentation, diagnosis, and management of ureterovaginal fistula over a 7-year period at a tertiary care center. Methods: A retrospective review of ureterovaginal fistula cases between 2003 and 2011 was performed. Demographic information, antecedent event, symptoms, diagnostic modalities, and management strategies were reviewed. Results: Nineteen ureterovaginal fistulas were identified during the 7-year study period. One fistula followed a repeat cesarean section and 18 fistulas followed a hysterectomy (9 total abdominal, 6 total laparoscopic, 3 vaginal hysterectomies). Ureteral injuries were not recognized in any of the patients at the time of index surgery. Computed tomography (CT) urography was the most commonly utilized diagnostic modality (58%). Primary non-surgical management with ureteral stents was attempted and successful in 5 out of 7 cases (71%). There were 14 total surgical repairs, including 2 cases in which stents were successfully placed, but the fistula persisted, and 6 additional cases where attempted stent placement failed. Surgical repair consisted of 10 ureteroneocystostomies performed via laparotomy and 4 performed laparoscopically, 3 of which were robotically assisted. Conclusions: Despite being uncommon, ureterovaginal fistula should remain in the differential diagnosis of new postoperative urinary incontinence after gynecological surgery. Conservative management with ureteral stent appears to be the best initial approach in selected patients, with a success rate of 71%. Minimally invasive approaches to performing ureteroneocystostomy have high success rates, comparable to those of open surgical repair. © The International Urogynecological Association 2013. Source


Falcone T.,Gynecology and Womens Health Institute
Gynecological Surgery | Year: 2010

Endometriosis has been one of the most confusing gynecological diseases since it was first described. Whereas there is a reasonable body of evidence in literature to demonstrate an association between endometriosis and infertility, a definite cause and effect relationship has not been established. The mechanism by which endometriosis causes infertility remains an enigma. Virtually every aspect of reproduction in women with endometriosis has been investigated and purported to be impaired. Impairment of implantation and pregnancy rates seems to affect women with endometriosis. Whether this is due to poor quality embryos derived from impaired oocytes or endometrial defects or both has been argued. Structural abnormalities of the uterine wall and tube in women with endometriosis have also been described by other researchers. Adding more confusion to this topic is the altered immune function and the peritoneal environment and their detrimental effects on the sperm motility and morphology. This uncertain pathophysiology has resulted in the lack of consensus on the treatment of endometriosis-associated infertility. The aim of this review is to describe the current pathophysiology of endometriosis-related infertility, how laparoscopic surgery may influence fertility rates. © 2010 Springer-Verlag. Source

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