1. The müllerian ducts normally develop into the fallopian tubes, uterus, cervix, and upper two-thirds of the vagina. Failures or abnormalities during development can result in müllerian duct anomalies.
2. Development occurs through three phases - organogenesis, fusion, and septal resorption. Failures in fusion can lead to bicornuate or didelphys uterus, while failed septal resorption causes septate uterus.
3. Müllerian duct anomalies have a variety of presentations including infertility, miscarriage, and obstructed reproductive systems. Diagnosis is made through ultrasound, hysterosalpingography, or laparoscopy.
Recurrent pregnancy loss is a significant redroductive medical problem, influencing 2%–5% of couples. ... Throughout the years, proof based medications, for example, surgical correction of uterine abnormalities or asprin and heparin for antiphospholipid syndrome have improved the results for couples with repetitive pregnancy loss.
Uterine fibroid (leiomyoma) and new treatment modalitiesMohammed Saadi
This presentation describes Uterine fibroid
Definition
Incidence
Etiology
Risk factors
Clinical manifestation
Red degeneration
Complications of fibroids
Management and the new modalities in treatment
India is the highest TB burden country accounting for more than one-fourth of the global incidence .Genital TB is found in 5-10% of women with infertility problems, with low rates in Australia (1%) and high rates of up to 19% in India (ICMR,2011)
Recurrent pregnancy loss is a significant redroductive medical problem, influencing 2%–5% of couples. ... Throughout the years, proof based medications, for example, surgical correction of uterine abnormalities or asprin and heparin for antiphospholipid syndrome have improved the results for couples with repetitive pregnancy loss.
Uterine fibroid (leiomyoma) and new treatment modalitiesMohammed Saadi
This presentation describes Uterine fibroid
Definition
Incidence
Etiology
Risk factors
Clinical manifestation
Red degeneration
Complications of fibroids
Management and the new modalities in treatment
India is the highest TB burden country accounting for more than one-fourth of the global incidence .Genital TB is found in 5-10% of women with infertility problems, with low rates in Australia (1%) and high rates of up to 19% in India (ICMR,2011)
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
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Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
Pharynx and Clinical Correlations BY Dr.Rabia Inam Gandapore.pptx
MULLERIAN DUCT ANOMALIES
1.
2. EMBRYOLOGY
Two paired müllerian ducts ultimately develop
into: fallopian tubes, uterus, cervix, and the
upper two thirds of the vagina.
3 phases of development as follows:
1. Organogenesis:
One or both müllerian ducts may not develop
fully, resulting in:
uterine agenesis or hypoplasia (bilateral) or
unicornuate uterus (unilateral).
ABOUBAKR ELNASHAR
4. 2. Fusion:
a.Lateral fusion of the lower segments of
the paired müllerian ducts form the
uterus, cervix, and upper vagina
Failure of fusion results in bicornuate or
didelphys uterus.
b. Vertical fusion: fusion of the ascending
sinovaginal bulb with the descending
müllerian system forms a normal patent
vagina
incomplete vertical fusion results in an
imperforate hymen.ABOUBAKR ELNASHAR
5. c. Septal resorption:
After the lower müllerian ducts fuse, a central
septum is present, which subsequently must be
resorbed to form a single uterine cavity and
cervix. Failure of resorption is the cause of
septate uterus.
ABOUBAKR ELNASHAR
7. ETIOLOGY
Although teratogenic exposures such as
thalidomide,
diethylstilbestrol (DES), and
radiation have been linked with these
abnormalities, the vast majority are likely
related to
polygenetic and
familial factors.
ABOUBAKR ELNASHAR
8. PREVALENCE
•True incidence and prevalence are difficult
to assess:
{Nonstandardized classification systems.
Differences in diagnostic data acquisition}
•Uncommon
•Most common of the female reproductive
tract anomalies
General population: 0.5%
Fertile women: 2-3%
Infertile women: 3%
Repeated miscarriages: 5-10%
ABOUBAKR ELNASHAR
12. II. Gynecology:
1. Infertility
2. Dysmenorrhea
3. Obstructed or partially obstructed müllerian
systems who present with
hematosalpinx, hematocolpos, retrograde
menses, and endometriosis.
III. Renal:
High association between müllerian duct
anomalies and renal anomalies such as
unilateral agenesis.
ABOUBAKR ELNASHAR
13. CLASSIFICATION
7 classes according to the American Fertility
Society (AFS) (1988):
Class I (hypoplasia/agenesis):
The most common form is the Mayer-
Rokitansky-Kuster-Hauser syndrome:
Combined agenesis of the uterus, cervix,
and upper portion of the vagina.
Patients have no reproductive potential
aside from medical intervention in the form
of IVF of harvested ova and implantation in
a host uterus.
DD: Testicular fiminization syndrome
ABOUBAKR ELNASHAR
15. Class II (unicornuate uterus):
• result from complete, or almost complete,
arrest of development of 1 müllerian duct
•If the arrest is incomplete, as in 90% of
patients, a rudimentary horn with or without
functioning endometrium is present.
•If the rudimentary horn is obstructed, it may
come to surgical attention when presenting as
an enlarging pelvic mass.
•If the contralateral healthy horn is almost fully
developed, a full-term pregnancy is believed
to be possible
ABOUBAKR ELNASHAR
16. Unicornuate uterus. Note the failure of the development
of one half of the uterus. This form may be associated
with a rudimentary horn arising from the contralateral
müllerian duct.
ABOUBAKR ELNASHAR
20. 1.Unicornuate with uterine horn (no with uterine horn
(no endometrial endometrial cavity) fused to
unicornuate uterus
2.Unicornuate uterus with noncommunicating horn
containing endometrial cavity not fused
ABOUBAKR ELNASHAR
21. Class III (didelphys uterus):
•results from complete nonfusion of both
müllerian ducts.
•The individual horns are fully developed and
almost normal in size. Two cervices are
inevitably present.
•Didelphys uteri have the highest association
with transverse vaginal septa.
•Consider metroplasty; however, since each
horn is almost a fully developed uterus,
patients have been known to carry
pregnancies to full term.
ABOUBAKR ELNASHAR
22. Didelphys uterus. Note
the complete separation
but full development of
each müllerian duct.
Uterine didelphys with
complete vaginal
septum
ABOUBAKR ELNASHAR
27. Class IV (bicornuate uterus):
• Results from: partial nonfusion of the müllerian ducts.
• Subtypes:
Bicornuate unicollis: The central myometrium extend to
the level of the internal cervical os
Bicornuate bicollis: The central myometrium extend to
the level of external cervical os.
ABOUBAKR ELNASHAR
28. • DD of bicornuate bicollis from didelphys uterus
1.it demonstrates some degree of fusion between the
two horns, while in classic didelphys uterus, the two
horns and cervices are separated completely.
2.the horns of the bicornuate uteri are not fully
developed; typically, they are smaller than those of
didelphys uteri.
• Some patients are surgical candidates for
metroplasty.
ABOUBAKR ELNASHAR
29. Bicornuate uterus. Note the partial fusion of the lower uterine
segment and persistently separated upper uterine segments.
Of key importance is the prominent fundal cleft (>1 cm), which
distinguishes the anomaly from septate uterus.
ABOUBAKR ELNASHAR
33. Class V (septate uterus):
•results from failure of resorption of the septum
between the two uterine horns.
•The septum can be partial or complete, in which
case it extends to the internal cervical os
•Histologically composed of: myometrium or fibrous
tissue.
•The uterine fundus is typically convex but may be
flat or slightly concave (<1-cm fundal cleft).
•Women with septate uterus have the highest
incidence of reproductive complications.
ABOUBAKR ELNASHAR
34. •DD between a septate and a bicornuate uterus is
important {septate uteri are treated using
transvaginal hysteroscopic resection of the septum,
while if surgery is possible and/or indicated for the
bicornuate uterus, an abdominal approach is required
to perform metroplasty}.
ABOUBAKR ELNASHAR
35. Bicornuate
•Fundus indented
•Variable degree of
separation of uterine
horns that can be
complete, partial or
minimal
•Minimal reproductive
problems, however can
have pregnancy loss, PTL
•HSG won’t dx, need
laparoscopy
Septate
•Normal external surface,
•need laparoscopy to dx
•Septum can cause
infertility,
recurrent midtrimester
loss
Septate or bicornuate?
ABOUBAKR ELNASHAR
36. Septate uterus. Midline
septum can be of
variable length and can
be muscular or fibrous. In
the diagram, the septum
is shown as an extension
of the uterine
myometrium.
Septate uterus. The midline
septum can extend for a variable
length and can be muscular or
fibrous. In the diagram, the
septum is thin and linear as
expected in the fibrous type. Since
the composition of the septum
varies, whether it is composed of
muscle or fibrous tissue is not a
means to distinguish septate from
other forms of uterine anomalies.
ABOUBAKR ELNASHAR
40. Class VI (arcuate uterus):
•The endometrial cavity demonstrates a small
fundal cleft or impression (>1.5 cm).
•The outer contour of the uterus is convex or
flat.
•This form is a normal variant {it is not
significantly associated with the increased
risks of pregnancy loss and the other
complications found in other subtypes}.
ABOUBAKR ELNASHAR
41. Arcuate uterus. Mild thickening of the midline fundal
myometrium resulting in fundal cavity indentation but
normal outer fundal contour. Some authors consider it a
normal variant. It is not associated with an increased
risk of obstetric/gynecologic complications.
ABOUBAKR ELNASHAR
42. Class VII (diethylstilbestrol-related
anomaly):
The uterine anomaly is seen in the female
offspring of as many as 15% of women
exposed to DES during pregnancy.
Uterus: hypoplasia and a T-shaped uterine
cavity.
Cervix: abnormal transverse ridges, hoods,
stenoses
Vagina: adenosis with increased risk of
vaginal clear cell carcinoma.
ABOUBAKR ELNASHAR
45. TeLinde's Modification of the American Fertility
Society Classification of Uterovaginal Anomalies[3]
Class I. Dysgenesis of the Mullerian Ducts
Class II. Disorders of Vertical Fusion of the Mullerian Ducts
Class III. Disorders of Lateral Fusion of the Mullerian Ducts
Class IV. Unusual Configuration of Vertical-Lateral Fusion Defects
ABOUBAKR ELNASHAR
46. CLINICAL PRESENTATION
Suggestion:
1.In the newborn/infant:
obstructed system: a palpable abdominal,
pelvic, or vaginal mass (mucocolpos).
2. In adolescent girl:
delayed menarche &/or an obstructed system
presenting as an intra-abdominal mass
(hematocolpos) cyclical pain.
3. Childbearing age:
infertility, repeated spontaneous abortions, or
PTL.
ABOUBAKR ELNASHAR
47. INVESTIGATION
1.US:
TAS and, if feasible, TVS
TVS 2D: Uterine anomalies may not be
excluded on the basis of negative US
findings.
3D: higher sensitivity and specificity
ABOUBAKR ELNASHAR
48. 2. HSG performed under fluoroscopy:
• Allows evaluation of the ut cavity and tubal
patency: Anomalies may be suggested
• HSG is the least accurate:
1. Positive findings often are nonspecific for
precise diagnosis
2.Visualization of 2 ut cavities on HSG does
not aid in distinguishing septate, didelphys&
bicornuate uteri
• It may not be possible to perform if there is
a lower abnormality prohibiting ut entry from
the vagina.
ABOUBAKR ELNASHAR
49. This was difficult to
differentiate as septate or
bicornuate uterus using
hysterosalpingography. It was
a surgically proven case of
bicornuate uterus.
Surgically proven case of
bicornuate uterus. Correct
diagnosis may be suggested
based on hysterosalpingography
findings, which are, most
notably, the widened intercornual
distance (>4 cm) and the
widened intercornual angle
(>60°).ABOUBAKR ELNASHAR
50. T-shaped uterus.
Classic
configuration of
the uterine cavity
in a typical
diethylstilbestrol-
exposed uterus
(American
Fertility Society
class VII). Uteri
are typically
hypoplastic. In
this patient, no
maternal history
of
diethylstilbestrol
exposure was
found.ABOUBAKR ELNASHAR
51. 3. MRI:
• Standard for imaging ut anomalies.
1. High-resolution images
2. Evaluate the urinary tract for concomitant
anomalies. In the past, intravenous urography was
used for this purpose.
3. Most types of ut anomalies can be diagnosed
• MRI is the most accurate, followed by TVS and
HSG.
ABOUBAKR ELNASHAR
52. Septate uterus :
outer fundal contour
(superior border) is flat or
slightly concave
Septate uterus:
a longer septum divides the
uterine cavity.
Outer fundal contour is flat.
ABOUBAKR ELNASHAR
53. Didelphys uterus:
a. Complete
separation and full
development of
both müllerian
ducts
b. Two vaginas
and 2 cervices
c. 2 distinct
cervices
d. 2 uterine horns
are widely
splayed; cross
section of
uterine bodies
and cervices.
ABOUBAKR ELNASHAR
54. Unicornuate uterus:
Full development of a single uterine horn and a
normal-appearing cervix. This anomaly was one
of many in this patient with Goldenhar syndrome.ABOUBAKR ELNASHAR
55. Septate uterus:
Thin, fibrous septum that cannot
be resolved distally at the
fundus.
Outer fundal contour is convex,
thus excluding a bicornuate
uterus.
Bicornuate bicollis:
The midline uterine external fundal cleft (superior
border) has a depression >1 cm, excluding septate
uterus
2 cervices are present.
Not didelphys uterus because some degree of fusion
has occurred between the lower uterine segments
(ie, they are fused, although the cavities are not
communicating).
ABOUBAKR ELNASHAR
56. 4. Hysteroscopy and laparoscopy:
employed to help with the diagnosis as well
as potential treatments, with similar
shortcomings related to hysteroscopy to
those seen with HSG.
It would be necessary to employ both
methods to differentiate a septum from a
bicornuate uterus.
ABOUBAKR ELNASHAR
58. MANAGEMENT
•Depend on:
1. The presence and severity of menstrual,
fertility , and sexual function problems.
2. The type of anomaly
The mere presence of an abnormality does
not necessitate treatment unless the patient is
symptomatic as a result of it.
ABOUBAKR ELNASHAR
59. Menstrual disturbances:
most commonly represented by
1. a transverse or blocking septum, but also 2.
absence of the vagina or cervical anomalies.
ABOUBAKR ELNASHAR
61. Infertility
Etiology:
problems relating to fertilization (due to
blockage of the sperm's path),
implantation, or pregnancy maintenance.
The type of abnormality will guide the
approach to treatment.
Many assisted reproductive techniques are
now available.
Uterine septum: hysteroscopic resection
ABOUBAKR ELNASHAR
62. Sexual function
can be affected in a couple of ways.
1.a complete absence of the vagina. In this
circumstance, normal intercourse would be
impossible and creation of a neovagina may
be appropriate.
2.In the case of both a transverse and
longitudinal septum, a physical barrier may
make intercourse difficult, painful, or even
impossible
Vaginal septum, if the patient is symptomatic,
can usually be treated with a simple
resection if small.
ABOUBAKR ELNASHAR
63. In cases of absence of the vagina:
I. If the uterus is present: creation of the
neovagina, with a communication to the cervix
II. If these do not exist, or if there is no uterus:
1. Nonsurgical methods should be employed
initially (the use of subsequently larger vaginal
dilators to stretch the area where the vagina is
to be created).
ABOUBAKR ELNASHAR
64. 2. Surgical procedures.
a. McIndoe:
A space is dissected between the rectum and
the bladder
a split-thickness skin graft from the buttocks is
used to form the vagina;
dilator at the time of the procedure creates
continuous dilation of the vagina while the
graft heals.
ABOUBAKR ELNASHAR
65. b. Other procedures:
Williams vulvovaginoplasty,
It uses full-thickness skin flaps from the labia
majora to create a vaginal pouch which axis
is directly posterior and horizontal to the
perineum; however, the vagina is functional
and well received by patients
Musculocutaneous flaps, and free intestinal
grafts. The decision of which approach to
take is dictated by the patient's
characteristics and needs.
ABOUBAKR ELNASHAR
66. c. IVF cycle through the myometrial wall. Therefore,
a direct connection of the uterine cavity to the vagina
through the cervix may not be an issue when
considering fertility problems.
When fertility is not an issue and the patient is
suffering from menstrual problems, hysterectomy
can be a consideration.
ABOUBAKR ELNASHAR