جستجوی مقالات مرتبط با کلیدواژه « perineum » در نشریات گروه « پزشکی »

Aggressive angiomyxoma (AA) is a rare and slow-growing tumor in the pelvic and perineal regions that might develop into other perineal structures. It can present variably, ranging from a painless mass to non-specific symptoms such as dyspareunia. Due to the high relapse rate, extensive tumoral resection is reasonably required to prevent recurrences. It is also commonly confused with other conditions such as lipomas, Bartholin’s gland cysts, and hernias.

A 43-yr-old female diagnosed with AA 10 yr ago was evaluated as a consequence of the tumor recurrence. She presented rare manifestations of a giant and cystic pelvic mass involving pararectal and paravaginal tissue in front of the sacrum.

Although AA is a rare and slow-growing tumor, close observation is recommended due to the high relapse rate. Furthermore, extensive tumoral resection and regular follow-up can reduce morbidity in these patients.

Defecatory dysfunction is a common problem among women who are referred for urogynecological care. Pelvic organs prolapse (POP) which is a downward displacement of pelvic organs is one of the common conditions among patients with defecatory problems. This study was planned to evaluate the correlation of obstructive defecatory symptoms with the site and severity of pelvic organ prolapse and the anorectal manometry results.

This cross-sectional study was performed between Dec 2018 and Nov 2019. A total of 150 women with symptoms of defecatory problems were enrolled. Patients were classified in two groups according to each compartment prolapse staging and severity: stage ≤2 and stage >2. The correlation between defecatory symptoms and pelvic organ prolapse examination, anorectal examination and anal manometry were evaluated.

A total of 150 women were evaluated. There was a significant correlation between higher stage of anterior compartment prolapse (cystocele stage>2) and constipation (P=0.035). Although all the defecatory symptoms were more frequent in anterior prolapse stage>2, but the difference was not significant (P>0.05). There was no significant correlation between defecatory symptoms and severity of posterior compartment prolapse. There was a significant correlation between stage>2 of apical prolapse and all the defecatory symptoms (P≤0.05). The abnormal anal resting and squeeze pressure and abnormal balloon expulsion test were more frequent in stage >2 of all compartments prolapse, but the difference was not significant (P>0.05).

Obstructed defecation syndrome was more frequent in patients with higher stages of anterior and apical prolapse. Abnormal manometry results were more frequent in patients with defecatory dysfunction with advanced vaginal prolapse.

Third- and fourth-degree perineal tears are considered severe, whose prevalence rate is different based on the population, place, and time, and several factors can be involved in their occurrence.

This study aims to determine the prevalence of severe perineal tears during normal vaginal delivery (NVD) and its risk factors among women in Qom, Iran.

This is a descriptive-analytical retrospective study with a case-control design, which was conducted on the medical records of women who gave birth from March 2010 to March 2019 in three teaching hospitals in Qom (n=115,107). Those with third- and fourth-degree perineal tears were put in the case group (n=138), and those with no severe perineal tears were considered as controls (n=138). Information was collected using a checklist surveying demographic information, previous medical history, and obstetric information. The data analysis was done using independent t-test, chi-square test, Fisher’s exact test, and multivariate logistic regression analysis. The significance level was set at 0.05.

Among 115,107 childbirths in the hospitals, 138 cases (0.12%) had third- and fourth-degree tears. The mean age of women was 27.00±4.64 years and their mean gestational age was 39.09±1.05 weeks. None of the mothers consumed alcohol, and only two were smokers. The birth weight of newborns, parity, length of the first and second stages of labor, nationality, and time of delivery were significantly different between the two groups (P<0.05). The results of the multivariate logistic regression analysis showed that only the variables of birth weight of newborn (OR=0.91, 95% CI; 0.96%-0.99%, P=0.009), length of the first stage of labor (OR=0.06, 95% CI; 0.02%-0.19%, P=0.001) and length of the second stage of labor (OR=0.04, 95% CI; 0.03%-1.1%, P=0.001) were the significant predictors of severe perineal tears.

the high birth weight of newborns and the prolongation of the first and second stages of labor are the risk factors for severe perineal tears. Therefore, it is recommended that obstetricians in Iran pay attention to these risk factors in the management of the labor process.

 Transperineal template prostate biopsies (TPTPB) are now increasingly commonly performed for the diagnosis of prostate cancer. TPTPB are traditionally performed under general anaesthetic. However, this poses a significant strain on hospital theatre capacity. As such, local anaesthetic (LA) TPTPB are becoming more popular. We describe a novel technique in performing the standard TPTPB under LA in the outpatient setting.

 Between February 2019- February 2021, 254 consecutive men (median age 69; range: 44-80 years) with a median PSA of 8.7 ng/ml (range: 2.2-76) underwent L/A TPTPB using our novel technique. This is whereby 50mls of 1% prilocaine was injected partially around the perineal skin and partially deep bilateral periprostatic areas. Multiple simultaneous prostate biopsies were then taken with the standard template grid and stepper.

 A total of 250/254 (98.4%) men underwent successful L/A TPTPB with a median visual analogue pain score of 4 (range: 2-8). The median prostate volume was 49cc (range: 14-240cc). The median number of cores taken were 18 (range: 14-24). A total of 163/250 men (65.2%) had a positive histology for prostate cancer with a median of 5 cores being involved with prostate cancer (range: 1-18). In addition, 101/163 men (62.0%) diagnosed with prostate cancer had either Gleason score 3+4=7 or greater. None experienced urosepsis and only 2/250 men (0.8%) had temporary urinary retention.

 Our novel LA technique in performing the standard TPTPB is safe, feasible and well tolerated and associated with a high rate of prostate cancer detection.

Birth-related perineal injuries, especially its severe degrees, could result in unpleasant childbirth experience and affect maternal and infant morbidities. Since, it is possible to improve the quality of care through understanding patients' expectations and experiences, this study was conducted to explore the perceptions and experiences of women with perineal injuries in postpartum care.

In this qualitative study, 22 women with various degrees of perineal trauma were purposively selected between 10 days to one year after childbirth from hospitals and healthcare centers in Mashhad, Iran in 2016. Data collection was carried out through in-depth, face-to-face semi-structured interviews.  Data were concurrently analyzed through conventional content analysis using inductive approach of Elo and kyngas (2008) following data organization by MAXQDA software (version 10).

Postpartum care of women with severe perineal injuries was explained as "unethical practices in care" with two emerged categories including "lack of professional responsibility" comprising two subcategories of "short term follow-up" and "neglect of comprehensive care " as well as unethical communications" consisting of three subcategories of "dishonesty", "inactive listening", and "lack of compassion".

Postpartum care in women with severe perineal trauma needs to be reviewed so that follow-up care and comprehensive provision of required services should be taken into account with focus on effective communication skills including honesty, active listening and compassion.

Perineal trauma is a common problem seen after vaginal delivery, which has negative effects on different aspects of women’s lives. Poor skin elasticity has been introduced as a predictor of perineal trauma, and the appearance of striae gravidarum is associated with poor skin elasticity. This review aimed to determine the association between perineal trauma and striae gravidarum through a systematic review and meta‑analysis.

We searched with MeSH terms (“Perineum” AND “Lacerations” OR “Rupture” AND “Striae Distensae”) and their equivalents in databases PubMed, Scopus, Science direct, Web of Science, ProQuest, Scientific Information Database (SID), Magiran, and Google Scholar search engine without time and language restrictions from the beginning of May until the beginning of September 2020. After reviewing the inclusion and exclusion criteria, and quality evaluation, ten articles were included in the systematic review, and we analyzed data of 6 articles using Stata ver 11.2.

The results indicated that the rate and severity of perineal trauma were directly related to the severity of striae gravidarum (OR = 8.28, 95%CI = 2.49–27.54, I² = 86.64%).

Based on the research results, the probability of perineal trauma was higher in individuals with moderate to severe striae than those with mild or without striae; therefore, we suggest evaluating striae score in the third trimester of pregnancy as a simple and noninvasive method to predict the risk of perineal trauma during childbirth. For reducing perineal injuries in women at risk, some supportive measures such as episiotomy and perineal massage are recommended.

 Episiotomy is a surgical incision in the perineal region to increase the vaginal diameter during delivery. Since the perineal region is not well visible to the mothers and there is a possibility of infection for the episiotomy wound by vaginal and rectal bacteria, such a cut is associated with infection and delay in wound healing.

 This study aimed to detect the effect of Olea ointment on episiotomy wound healing among primiparous women.

 This randomized controlled clinical trial included 73 women referring to the Al-Zahra Education, Research, and Remedial Center in Rasht, Iran, during 2017 - 18. Women were randomly assigned into two groups: Intervention group (n = 39) and control group (n = 34). Episiotomy wound healing was assessed using the REEDA scale prior to the intervention, 2 and 24 hours following the first intervention, and 5 and 10 days after delivery. Statistical analysis was performed using Fisher’s exact test, Mann-Whitney U test, independent t-test, repeated-measure test, Friedman test, and chi-square.

 The mean baseline scores of REEDA was 2.72 ± 0.46 in the Olea ointment group and 2.71 ± 0.46 in the control group; however, there was no statistically significant difference between the two groups. On the other hand, the episiotomy healing scores in the Olea ointment group were significantly lower than those of the control group at four intervals in the follow-up assessments: -0.34 (95% CI: -0.56 to -0.12) two hours after intervention, -0.63(95% CI: -0.89 to -0.37) 24 hours after intervention, -0.30 (95% CI: -0.48 to -0.12) on Day 5 postpartum, and -0.29 (95% CI: -0.46 to -0.13) on Day 10 postpartum.

 The present findings suggested that the Olea ointment facilitated wound healing of episiotomy; however, further studies are suggested to support these data.
 

Extralevator Abdominoperineal Excision (ELAPE) and Abdominoperineal Resection create complex perineal defects made more challenging when combined with additional resection of the posterior vaginal wall. This composite defect requires the restoration of a functional vagina, in addi-tion to the obliteration of the large perineal dead space, a need to reduce donor site, and perineal wound morbidity. Previously described fasciocu-taneous and myocutaneous flaps for such defects are associated with long operations requiring intra-operative mobilization and are linked to post-operative complications including herniation, evisceration, flap loss, donor site morbidity and poor cosmetic outcome, amongst other issues. Herein we describe the case of a 60-year-old female patient that underwent com-bined ELAPE and posterior vaginectomy for anal squamous cell carcino-ma. This complex defect was reconstructed using an extended version of the Perineal Turn-Over (PTO) flap based on the Internal Pudendal artery perforator.

Leiomyomas are tumors of the soft tissues. The incidence of myomas within the perineum is absolutely rare and only a few reports have been made on the matter. We herein report a case of perineal myoma in a virgin woman, which was successfully excised.

Case report:

 We present a 35-year-old virgin woman, with complaint referred to a mass in her perineum which had first exhibited signs 5 years prior to the time she referred to us and had increased in size in a steady manner ever since. The mass had caused no gynecologic, rectal, or urinary symptoms. Clinical examination revealed a painless, mobile mass (6cm*6cm) with [unknown consistency] in the right perineum with extension to the distal of the labium majus of the same side.

Treatment of symptomatic leiomyomas relies on surgical excision of the mass. However, the surgical method of choice is a matter of debate in previous studies.

</strong>Social recovery during the postnatal period in women with perineal trauma is a  little‑known concept. Therefore, this study was designed to explore the experiences of social recovery  in women with childbirth‑related perineal trauma.

</strong>A qualitative approach  using content analysis was adopted to study a purposive sample of 22 postnatal women with perineal  trauma during birth at Omol‑banin Hospital, Mashhad, Iran from April 20th to December 25th, 2017.  The participants were selected between 10 days to one year after childbirth. Data were collected  through semi‑structured interviews. Conventional content analysis approach was performed,  concurrently, with data collection. To organize data, the MAXQDA 10 was used.

</strong>Social  recovery after perineal trauma was conceptualized as ‘shifting from personal ill‑health to interactional  empowerment’. Two generic categories emerged from data analysis including 1) impaired individual  and social function, which was recognized by social isolation and lack of ability to manage daily life  and 2) empowering social interactions, which was characterized by rebuilding social partnerships  and returning to an interactive lifestyle.

</strong>Social isolation as the result of neglecting  social recovery of women with severe perineal trauma endangers the mental health of mothers.  Understanding the concept of social recovery for women with perineal trauma, especially in severe  cases, will help health professionals to provide quality postpartum care for women with perineal  trauma in a longer period after childbirth.

Perineal lacerations resulting from vaginal delivery may cause short and long complications, which lead to some problems in women after the delivery. Ostrich oil is safe for use in skincare and beauty products. The aim of this study was to examine the effect of perineal massage with Ostrich oil on the episiotomy and lacerations in nulliparous women. 

This single‑blind randomized controlled trial was conducted on 77 nulliparous women referred to Razi Hospital in Qazvin (Iran) from May to December 2018. After screening of potential participants, 80 out of 105 pregnant women were selected by convenience sampling and were assigned into the intervention and control groups by block randomization technique. In the intervention group, participants received a perineal massage with Ostrich oil in the active phase and the second stage of labor. The rates of episiotomy and perineal laceration were compared between the two groups. Data were analyzed using Chi-square, t</em>-test and Mann-Whitney.

Perineal massage with Ostrich oil in the intervention group significantly decreased the rate of episiotomy compared to the control group (x</em>2 = 18.32, df = 1, p </em>< 0.001). However, there was no statistically significant difference in perineal lacerations between the two groups.

The results revealed that perineal massage with Ostrich oil could be recommended as an effective, safe, and inexpensive method to improve the rate of episiotomy in vaginal delivery. Perineal massage can be performed by midwives in the first and second stages of labor.