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Mitchel S. Hoffman - One of the best experts on this subject based on the ideXlab platform.
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Upper Vaginectomy for the treatment of vaginal intraepithelial neoplasia.
American journal of obstetrics and gynecology, 2005Co-Authors: Megan D. Indermaur, Martin A Martino, James V. Fiorica, William S. Roberts, Mitchel S. HoffmanAbstract:Objective The purpose of this study was to evaluate the use of upper Vaginectomy for the treatment of vaginal intraepithelial neoplasia (VAIN). Study design We conducted a retrospective review. Between August 1, 1985 and April 30, 2004, 105 patients were identified who had undergone upper Vaginectomy for VAIN. Results Thirty-six patients had previously been treated for VAIN. Mean operative time and estimated blood loss were 55 minutes and 113 mL, respectively. Ten percent had intraoperative complications. Twenty-three (22%) patients had negative findings on final pathologic examination, and invasive cancer was found in 13 (12%) patients. Four patients had postoperative complications. Follow-up was available in 52 patients; 46 (88%) remain without recurrence at a mean follow-up of 25 months. Conclusion In our patients, upper Vaginectomy was efficacious for the treatment of VAIN. The procedure led to the diagnosis of occult invasive cancer in 12% of these women.
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Upper Vaginectomy for the Treatment of Vaginal Intraepithelial Neoplasia
Obstetrical & Gynecological Survey, 2005Co-Authors: Megan D. Indermaur, Martin A Martino, James V. Fiorica, William S. Roberts, Mitchel S. HoffmanAbstract:To evaluate the outcomes of patients with vaginal intraepithelial neoplasia (VAIN) who were treated by upper Vaginectomy, the medical records at the University of Florida between August 1985 and April 2004 were reviewed. One hundred five patients with VAIN 1 or 2 who had undergone upper Vaginectomy were identified. Colposcopy was routinely performed before surgery to verify that disease was confined to the upper one third of the vagina. All procedures were done in the operating room under general anesthesia. Most patients were discharged the day after surgery. Follow up consisted of cervical smears performed every 3 to 4 months for at least a year, every 6 months for the next year, then annually. The mean age of patients was 58 years (range, 28-85 years). All patients except one had undergone previous hysterectomy, most commonly for treatment of premalignant or malignant disease (64%). Ten women had previous radiation therapy. Thirty-four percent had undergone previous treatment for VAIN with laser vaporization, topical 5-fluoracil, and/or upper Vaginectomy. The average length of surgery was 55 minutes (range, 12-135 minutes). Median blood loss was 50 mL, but ranged from 25 mL to 1150 mL in a woman with thrombocytopenia and a histologic diagnosis of microinvasive squamous cell carcinoma. Four other patients had blood loss greater than 500 mL. Premature ventricle contractions developed in one woman, and 5 sustained an intraoperative cystotomy. In the postoperative period, 2 patients had a spinal headache, one had a fever thought to -be the result of cellulitis at the incision site, and one required vaginal packing 3 weeks after surgery to control bleeding of approximately 1000 mL. No disease was seen in the VAIN specimen in 23 (22%) of patients. None of these patients developed a recurrence of disease during follow up (range, 18-208 weeks). Invasive squamous cell carcinoma was found in 13 patients, 6 of whom undergone previous treatment for VAIN. Eight of the 13 had invasive disease and were treated with radiation therapy. Seven women had undergone previous hysterectomy, 3 for cervical cancer, 3 for carcinoma in situ of the cervix, and one reason was unknown. One patient died from disease 23 months after treatment and one was lost to follow up. Six were disease-free after 22 to 82 months of follow up. The remaining 5 positive patients were diagnosed with microinvasive carcinoma less than 2 mm in depth. Four of these women had been treated for carcinoma of the cervix. One patient developed a superficially invasive squamous cell carcinoma of the vagina 31 months after treatment. Three patients were alive without disease after 31 to 54 months of follow up, and one was lost to follow up. VAIN, grades 1 to 3, was diagnosed in the remaining 69 patients, 52 of whom had follow-up data. Forty-six (88%) were alive without disease after a mean follow up of 25 months (range, 4-90 months). Among the 6 patients who had a recurrence of disease, the mean time to recurrence was 24 months (range, 8-53 months). Five of these women had grade 3 VAIN in the pathologic diagnosis at the time of the original treatment. Patients were treated with radiation therapy, repeat upper Vaginectomy, topical 5-fluoruracil, or laser vaporization.
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Vaginectomy with pelvic herniorrhaphy for prolapse
American journal of obstetrics and gynecology, 2003Co-Authors: Mitchel S. Hoffman, Richard J. Cardosi, Jorge L. Lockhart, Douglas C Hall, Sandra J MurphyAbstract:Abstract OBJECTIVE: The study was undertaken to report our experience with Vaginectomy and pelvic herniorrhaphy for vaginal prolapse. STUDY DESIGN: This was an observational study of patients undergoing Vaginectomy (n = 41) or hysteroVaginectomy (n = 13) for stage III/IV vaginal prolapse. Morbidity was compared with cohorts who had undergone transvaginal repair of prolapse, by using the Mann-Whitney U test. RESULTS: Morbidity did not differ significantly (estimated blood loss) between the Vaginectomy and hysteroVaginectomy groups. There were no recurrent hernias (6-56 months). Operative time, estimated blood loss, and day of discharge were significantly greater for the posthysterectomy prolapse group compared with the Vaginectomy group. Operative time was significantly greater for the uterovaginal prolapse group versus the hysteroVaginectomy group. CONCLUSIONS: Vaginectomy with or without hysterectomy with pelvic herniorrhaphy is associated with a low rate of morbidity in a high-risk patient population. HysteroVaginectomy is not associated with a clinically significant difference in morbidity over Vaginectomy alone. Vaginectomy with or without hysterectomy should be offered as a surgical option to selected patients with severe genital prolapse.
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upper Vaginectomy for in situ and occult superficially invasive carcinoma of the vagina
American Journal of Obstetrics and Gynecology, 1992Co-Authors: Mitchel S. Hoffman, James V. Fiorica, William S. Roberts, Steven L Decesare, Michael A Finan, Denis CavanaghAbstract:Between Aug. 1, 1985, and July 31, 1990, 32 patients underwent upper Vaginectomy for grade 3 vaginal intraepithelial neoplasia. Thirty-one of these patients had undergone hysterectomy, 25 because of cervical neoplasia. Fourteen patients had undergone treatment for vaginal intraepithelial neoplasia. Nine (28%) had invasive cancer on final pathologic examination. Among the remaining 23 patients, recurrence of vaginal neoplasia developed in four (17%), with a mean time to recurrence of 78 weeks, and one was found to have superficial invasion at the time of recurrence. The remaining 19 patients remain alive with no evidence of recurrent disease at a mean follow-up interval of 152 weeks. In our patients upper Vaginectomy was efficacious for the diagnosis of occult invasive carcinoma of the vagina and for the treatment of in situ and superficially invasive carcinoma of the vagina.
Christopher J. Salgado - One of the best experts on this subject based on the ideXlab platform.
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Total Vaginectomy and urethral lengthening at time of neourethral prelamination in transgender men
International Urogynecology Journal, 2018Co-Authors: Carlos A. Medina, Lydia A. Fein, Christopher J. SalgadoAbstract:Introduction and hypothesis For transgender men (TGM), gender-affirmation surgery (GAS) is often the final stage of their gender transition. GAS involves creating a neophallus, typically using tissue remote from the genital region, such as radial forearm free-flap phalloplasty. Essential to this process is Vaginectomy. Complexity of vaginal fascial attachments, atrophy due to testosterone use, and need to preserve integrity of the vaginal epithelium for tissue rearrangement add to the intricacy of the procedure during GAS. We designed the technique presented here to minimize complications and contribute to overall success of the phalloplasty procedure. Methods After obtaining approval from the Institutional Review Board, our transgender (TG) database at the University of Miami Hospital was reviewed to identify cases with Vaginectomy and urethral elongation performed at the time of radial forearm free-flap phalloplasty prelamination. Surgical technique for posterior Vaginectomy and anterior vaginal wall-flap harvest with subsequent urethral lengthening is detailed. Results Six patients underwent total Vaginectomy and urethral elongation at the time of radial forearm free-flap phalloplasty prelamination. Mean estimated blood loss (EBL) was 290 ± 199.4 ml for the Vaginectomy and urethral elongation, and no one required transfusion. There were no intraoperative complications (cystotomy, ureteral obstruction, enterotomy, proctotomy, or neurological injury). One patient had a urologic complication (urethral stricture) in the neobulbar urethra. Conclusions Total Vaginectomy and urethral lengthening procedures at the time of GAS are relatively safe procedures, and using the described technique provides excellent tissue for urethral prelamination and a low complication rate in both the short and long term.
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Total Vaginectomy and urethral lengthening at time of neourethral prelamination in transgender men
International urogynecology journal, 2017Co-Authors: Carlos A. Medina, Lydia A. Fein, Christopher J. SalgadoAbstract:For transgender men (TGM), gender-affirmation surgery (GAS) is often the final stage of their gender transition. GAS involves creating a neophallus, typically using tissue remote from the genital region, such as radial forearm free-flap phalloplasty. Essential to this process is Vaginectomy. Complexity of vaginal fascial attachments, atrophy due to testosterone use, and need to preserve integrity of the vaginal epithelium for tissue rearrangement add to the intricacy of the procedure during GAS. We designed the technique presented here to minimize complications and contribute to overall success of the phalloplasty procedure. After obtaining approval from the Institutional Review Board, our transgender (TG) database at the University of Miami Hospital was reviewed to identify cases with Vaginectomy and urethral elongation performed at the time of radial forearm free-flap phalloplasty prelamination. Surgical technique for posterior Vaginectomy and anterior vaginal wall-flap harvest with subsequent urethral lengthening is detailed. Six patients underwent total Vaginectomy and urethral elongation at the time of radial forearm free-flap phalloplasty prelamination. Mean estimated blood loss (EBL) was 290 ± 199.4 ml for the Vaginectomy and urethral elongation, and no one required transfusion. There were no intraoperative complications (cystotomy, ureteral obstruction, enterotomy, proctotomy, or neurological injury). One patient had a urologic complication (urethral stricture) in the neobulbar urethra. Total Vaginectomy and urethral lengthening procedures at the time of GAS are relatively safe procedures, and using the described technique provides excellent tissue for urethral prelamination and a low complication rate in both the short and long term.
Kenneth D. Hatch - One of the best experts on this subject based on the ideXlab platform.
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laparoscopic assisted parametrectomy upper Vaginectomy lpuv technique applications and results
Gynecologic Oncology, 2005Co-Authors: Markus C. Fleisch, Kenneth D. HatchAbstract:Abstract Objective. In this analysis, we summarize our experiences with the laparoscopic parametrectomy/upper Vaginectomy (LPUV) as a treatment option for patients with an unexpected finding of cervical cancer after simple hysterectomy as well as for patients with cancer of the vaginal cuff. Methods. From 1995–2004, 6 of our patients underwent LPUV including 5 patients with stage Ib 1 cervical cancer and one patient with Ia 1 cervical cancer. Prior procedures were TVH ( n = 3), TAH ( n = 2) or LAVH ( n = 1). Charts were reviewed and follow-up data were collected. Results. Mean age was 40.5 (38–49) years and Quetelet index was 31.5 (25–40) kg/m 2 . Average time from hysterectomy to LPUV was 54 (30–84) days. Retrospective FIGO staging revealed stage Ib 1 ( n = 5) and stage Ia 1 ( n = 1) cervical cancer. Mean duration of surgery was 207 (151–265) min, average blood loss 300 (100–500) mL. One patient had an intraoperative bladder injury and one patient a bowel injury. Histopathological evaluation found residual adenocarcinoma in situ in one patient and no malignancy in all other specimen. All pelvic (average 22 (10–36) nodes, n = 6) and paraaortic nodes (9 nodes, n = 1) were negative for malignancy. One patient had postoperative hematocrit drop and required blood transfusion, mean hematocrit difference pre- vs. postoperative was 6.4 (0.2–10.9) %. There were no further postoperative complications during the average hospital stay of 3.5 (2–5) days. No patient required adjuvant therapy after the operation. There were no recurrences or late complications in an average of 21.5 (3–50) months of follow-up. Conclusion. LPUV is an alternative to open parametrectomy or radiation therapy in patients with unexpected cervical cancer after simple hysterectomy or cancer of the vaginal stump. Bladder injuries must be considered to be a specific complication of this otherwise safe procedure.
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Laparoscopic assisted parametrectomy/upper Vaginectomy (LPUV)-technique, applications and results.
Gynecologic oncology, 2005Co-Authors: Markus C. Fleisch, Kenneth D. HatchAbstract:Abstract Objective. In this analysis, we summarize our experiences with the laparoscopic parametrectomy/upper Vaginectomy (LPUV) as a treatment option for patients with an unexpected finding of cervical cancer after simple hysterectomy as well as for patients with cancer of the vaginal cuff. Methods. From 1995–2004, 6 of our patients underwent LPUV including 5 patients with stage Ib 1 cervical cancer and one patient with Ia 1 cervical cancer. Prior procedures were TVH ( n = 3), TAH ( n = 2) or LAVH ( n = 1). Charts were reviewed and follow-up data were collected. Results. Mean age was 40.5 (38–49) years and Quetelet index was 31.5 (25–40) kg/m 2 . Average time from hysterectomy to LPUV was 54 (30–84) days. Retrospective FIGO staging revealed stage Ib 1 ( n = 5) and stage Ia 1 ( n = 1) cervical cancer. Mean duration of surgery was 207 (151–265) min, average blood loss 300 (100–500) mL. One patient had an intraoperative bladder injury and one patient a bowel injury. Histopathological evaluation found residual adenocarcinoma in situ in one patient and no malignancy in all other specimen. All pelvic (average 22 (10–36) nodes, n = 6) and paraaortic nodes (9 nodes, n = 1) were negative for malignancy. One patient had postoperative hematocrit drop and required blood transfusion, mean hematocrit difference pre- vs. postoperative was 6.4 (0.2–10.9) %. There were no further postoperative complications during the average hospital stay of 3.5 (2–5) days. No patient required adjuvant therapy after the operation. There were no recurrences or late complications in an average of 21.5 (3–50) months of follow-up. Conclusion. LPUV is an alternative to open parametrectomy or radiation therapy in patients with unexpected cervical cancer after simple hysterectomy or cancer of the vaginal stump. Bladder injuries must be considered to be a specific complication of this otherwise safe procedure.
Carlos A. Medina - One of the best experts on this subject based on the ideXlab platform.
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Total Vaginectomy and urethral lengthening at time of neourethral prelamination in transgender men
International Urogynecology Journal, 2018Co-Authors: Carlos A. Medina, Lydia A. Fein, Christopher J. SalgadoAbstract:Introduction and hypothesis For transgender men (TGM), gender-affirmation surgery (GAS) is often the final stage of their gender transition. GAS involves creating a neophallus, typically using tissue remote from the genital region, such as radial forearm free-flap phalloplasty. Essential to this process is Vaginectomy. Complexity of vaginal fascial attachments, atrophy due to testosterone use, and need to preserve integrity of the vaginal epithelium for tissue rearrangement add to the intricacy of the procedure during GAS. We designed the technique presented here to minimize complications and contribute to overall success of the phalloplasty procedure. Methods After obtaining approval from the Institutional Review Board, our transgender (TG) database at the University of Miami Hospital was reviewed to identify cases with Vaginectomy and urethral elongation performed at the time of radial forearm free-flap phalloplasty prelamination. Surgical technique for posterior Vaginectomy and anterior vaginal wall-flap harvest with subsequent urethral lengthening is detailed. Results Six patients underwent total Vaginectomy and urethral elongation at the time of radial forearm free-flap phalloplasty prelamination. Mean estimated blood loss (EBL) was 290 ± 199.4 ml for the Vaginectomy and urethral elongation, and no one required transfusion. There were no intraoperative complications (cystotomy, ureteral obstruction, enterotomy, proctotomy, or neurological injury). One patient had a urologic complication (urethral stricture) in the neobulbar urethra. Conclusions Total Vaginectomy and urethral lengthening procedures at the time of GAS are relatively safe procedures, and using the described technique provides excellent tissue for urethral prelamination and a low complication rate in both the short and long term.
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Total Vaginectomy and urethral lengthening at time of neourethral prelamination in transgender men
International urogynecology journal, 2017Co-Authors: Carlos A. Medina, Lydia A. Fein, Christopher J. SalgadoAbstract:For transgender men (TGM), gender-affirmation surgery (GAS) is often the final stage of their gender transition. GAS involves creating a neophallus, typically using tissue remote from the genital region, such as radial forearm free-flap phalloplasty. Essential to this process is Vaginectomy. Complexity of vaginal fascial attachments, atrophy due to testosterone use, and need to preserve integrity of the vaginal epithelium for tissue rearrangement add to the intricacy of the procedure during GAS. We designed the technique presented here to minimize complications and contribute to overall success of the phalloplasty procedure. After obtaining approval from the Institutional Review Board, our transgender (TG) database at the University of Miami Hospital was reviewed to identify cases with Vaginectomy and urethral elongation performed at the time of radial forearm free-flap phalloplasty prelamination. Surgical technique for posterior Vaginectomy and anterior vaginal wall-flap harvest with subsequent urethral lengthening is detailed. Six patients underwent total Vaginectomy and urethral elongation at the time of radial forearm free-flap phalloplasty prelamination. Mean estimated blood loss (EBL) was 290 ± 199.4 ml for the Vaginectomy and urethral elongation, and no one required transfusion. There were no intraoperative complications (cystotomy, ureteral obstruction, enterotomy, proctotomy, or neurological injury). One patient had a urologic complication (urethral stricture) in the neobulbar urethra. Total Vaginectomy and urethral lengthening procedures at the time of GAS are relatively safe procedures, and using the described technique provides excellent tissue for urethral prelamination and a low complication rate in both the short and long term.
Markus C. Fleisch - One of the best experts on this subject based on the ideXlab platform.
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laparoscopic assisted parametrectomy upper Vaginectomy lpuv technique applications and results
Gynecologic Oncology, 2005Co-Authors: Markus C. Fleisch, Kenneth D. HatchAbstract:Abstract Objective. In this analysis, we summarize our experiences with the laparoscopic parametrectomy/upper Vaginectomy (LPUV) as a treatment option for patients with an unexpected finding of cervical cancer after simple hysterectomy as well as for patients with cancer of the vaginal cuff. Methods. From 1995–2004, 6 of our patients underwent LPUV including 5 patients with stage Ib 1 cervical cancer and one patient with Ia 1 cervical cancer. Prior procedures were TVH ( n = 3), TAH ( n = 2) or LAVH ( n = 1). Charts were reviewed and follow-up data were collected. Results. Mean age was 40.5 (38–49) years and Quetelet index was 31.5 (25–40) kg/m 2 . Average time from hysterectomy to LPUV was 54 (30–84) days. Retrospective FIGO staging revealed stage Ib 1 ( n = 5) and stage Ia 1 ( n = 1) cervical cancer. Mean duration of surgery was 207 (151–265) min, average blood loss 300 (100–500) mL. One patient had an intraoperative bladder injury and one patient a bowel injury. Histopathological evaluation found residual adenocarcinoma in situ in one patient and no malignancy in all other specimen. All pelvic (average 22 (10–36) nodes, n = 6) and paraaortic nodes (9 nodes, n = 1) were negative for malignancy. One patient had postoperative hematocrit drop and required blood transfusion, mean hematocrit difference pre- vs. postoperative was 6.4 (0.2–10.9) %. There were no further postoperative complications during the average hospital stay of 3.5 (2–5) days. No patient required adjuvant therapy after the operation. There were no recurrences or late complications in an average of 21.5 (3–50) months of follow-up. Conclusion. LPUV is an alternative to open parametrectomy or radiation therapy in patients with unexpected cervical cancer after simple hysterectomy or cancer of the vaginal stump. Bladder injuries must be considered to be a specific complication of this otherwise safe procedure.
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Laparoscopic assisted parametrectomy/upper Vaginectomy (LPUV)-technique, applications and results.
Gynecologic oncology, 2005Co-Authors: Markus C. Fleisch, Kenneth D. HatchAbstract:Abstract Objective. In this analysis, we summarize our experiences with the laparoscopic parametrectomy/upper Vaginectomy (LPUV) as a treatment option for patients with an unexpected finding of cervical cancer after simple hysterectomy as well as for patients with cancer of the vaginal cuff. Methods. From 1995–2004, 6 of our patients underwent LPUV including 5 patients with stage Ib 1 cervical cancer and one patient with Ia 1 cervical cancer. Prior procedures were TVH ( n = 3), TAH ( n = 2) or LAVH ( n = 1). Charts were reviewed and follow-up data were collected. Results. Mean age was 40.5 (38–49) years and Quetelet index was 31.5 (25–40) kg/m 2 . Average time from hysterectomy to LPUV was 54 (30–84) days. Retrospective FIGO staging revealed stage Ib 1 ( n = 5) and stage Ia 1 ( n = 1) cervical cancer. Mean duration of surgery was 207 (151–265) min, average blood loss 300 (100–500) mL. One patient had an intraoperative bladder injury and one patient a bowel injury. Histopathological evaluation found residual adenocarcinoma in situ in one patient and no malignancy in all other specimen. All pelvic (average 22 (10–36) nodes, n = 6) and paraaortic nodes (9 nodes, n = 1) were negative for malignancy. One patient had postoperative hematocrit drop and required blood transfusion, mean hematocrit difference pre- vs. postoperative was 6.4 (0.2–10.9) %. There were no further postoperative complications during the average hospital stay of 3.5 (2–5) days. No patient required adjuvant therapy after the operation. There were no recurrences or late complications in an average of 21.5 (3–50) months of follow-up. Conclusion. LPUV is an alternative to open parametrectomy or radiation therapy in patients with unexpected cervical cancer after simple hysterectomy or cancer of the vaginal stump. Bladder injuries must be considered to be a specific complication of this otherwise safe procedure.
