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DRCOG MCQs for Circuit C Questions
Published in Una F. Coales, DRCOG: Practice MCQs and OSCEs: How to Pass First Time three Complete MCQ Practice Exams (180 MCQs) Three Complete OSCE Practice Papers (60 Questions) Detailed Answers and Tips, 2020
Indications for Caesarean section include:Cephalopelvic disproportion.Placenta praevia.After vesicovaginal fistula repair.Transverse lie.Brow presentation.
Practice circuit 1
Published in T. Justin Clark, Arri Coomarasamy, Justin Chu, Paul Smith, Get Through MRCOG Part 3, 2019
T. Justin Clark, Arri Coomarasamy, Justin Chu, Paul Smith
Questions to be asked: What diagnoses do you suspect?What would your next steps be to confirm or refute the diagnosis?A small vesico-vaginal is confirmed on micturating cystogram. The IVU is normal. What would your next steps be in the management of this patient?Now the vesico-vaginal fistula diagnosis is confirmed, you go to speak to the patient. What would you tell the patient?Why can a vesico-vaginal fistula occur?What would you do after care is taken over by the urologists?
Fistula repair
Published in J. Richard Smith, Giuseppe Del Priore, Robert L. Coleman, John M. Monaghan, An Atlas of Gynecologic Oncology, 2018
Immediate management should also include attention to palliation and skin care, nutrition, physiotherapy, rehabilitation, and overall patient morale. In women wishing to avoid surgery and where bladder drainage is unsuccessful, other conservative treatments may be indicated when the vesicovaginal fistula is very small. Small series and case reports have indicated success with fibrin glue (Shekarriz and Stoller 2002), electrofulguration, laser ablation (Dogra and Saini 2011), or combinations of these modalities; no large series, however, have confirmed their value.
The Manchester operation – is it time for it to return to our surgical armamentarium in the twenty-first century?
Published in Journal of Obstetrics and Gynaecology, 2022
Ronen S. Gold, Hadar Amir, Yoav Baruch, David Gordon, Mordechai Shimonov, Asnat Groutz
There were four cases of late postoperative complications that required surgical intervention: vesicovaginal fistula, hematometra, pyometra and transvaginal small bowel evisceration. All four patients underwent uneventful Manchester operation. Three of the four patients underwent concomitant anterior and posterior colporrhaphy, two of whom also underwent TVT-O. The first patient (age 67 years, BMI 29.5) had vesicovaginal fistula that was diagnosed two months postoperatively. The second patient (age 45 years, BMI 22.6) underwent drainage of hematometra three months postoperatively with complete recovery thereafter. The third patient (age 67 years, BMI 24.2) presented with abdominal pain and fever 6 months after surgery. The presumed diagnosis following physical examination, pelvic sonography and lab tests was pyometra. The patient underwent total abdominal hysterectomy after a failed hysteroscopic attempt to drain the pyometra. The forth patient (age 57 years, BMI 19) presented 9 days after surgery with small bowel evisceration through the posterior vaginal fornix. Her past medical history has been unremarkable, with the exception of underweight and a trans urethral removal of bladder tumour (TURBT) for early stage bladder cancer 5 years earlier. The patient underwent emergency laparotomy in which the intestine was inspected and the posterior vaginal fornix was sutured. Her postoperative follow up was unremarkable.
Retrospective review of 37.4 Gy in 11 fractions for the palliation of advanced cervical cancer
Published in Southern African Journal of Gynaecological Oncology, 2021
Andriani K Morphis, Hildah Napo, Gina Joubert
Patients often present with urinary frequency, painful urination, haematuria or vesicovaginal fistula.10 These symptoms were not evaluated at follow-up visits after radiation. Pelvic radiation is also known to cause dysuria and haematuria as a side effect of radiation.15 As there was no quality-of-life scoring system, the pre- and post- treatment urinary symptoms were not assessed. It would also be difficult to determine who developed a vesicovaginal fistula because of the radiation alone, due to the shrinkage of the tumour after radiation therapy or because of tumour progression after radiation. As urinary symptoms are not symptoms looked at in the literature, they were not included in the main objective of the study. It is, however, recommended that future studies could focus on the side-effect profile of this radiation schedule.
Outcomes of reconstructive urinary tract surgery after pelvic radiotherapy
Published in Scandinavian Journal of Urology, 2019
Bogdan Toia, Jai Seth, Hazel Ecclestone, Mahreen Pakzad, Rizwan Hamid, Tamsin Greenwell, Jeremy Ockrim
Salvage of radiotherapy fistulae proved very difficult. Vaginal closure was only attempted in six of 22 (27%) of patients and failed in half of these. Abdominal closure was eventually achieved in two further patients, but the remaining 73% of patients ended with urinary diversions. The literature relating to vesicovaginal fistulae repair within radiotherapy is sparse, and, although 49 articles on vesicovaginal fistula repair have been reported in the literature [21], only 268 of 2,055 (13%) repairs were performed in radiotherapy cases. The majority of these repairs come from a single series. In 2009, Pushkar et al. [22] published on 216 fistula repairs following radical hysterectomy and radiotherapy. Surgery was performed via the vagina in the majority, with Martius fat pad in 41.0% of cases and Latzko colpocleisis in 35.7% of cases, with only 2.8% attempted by trans-abdominal route. The initial success rate was 48.1%, although 66.6% were closed by repeated surgery. None of these patients required another intervention for associated complications (stricture or contracture) so it is hard to draw direct comparative conclusions to the outcomes reported in this series. Nevertheless, it is clear that closure of urogenital in radiotherapy fields is a significant challenge.