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Vaginal Birth after Caesarean Section
Paymová, Lenka ; Rušavý, Zdeněk (advisor) ; Ulčová-Gallová, Zdeňka (referee) ; Švabík, Kamil (referee)
Vaginal birth after a previous caesarean section is a very actual topic for its potential in reduction of caesarean section rates. It has been widely discussed and studied in the world literature. Numerous guidelines dealing with management of this birth and the identification of both positive and negative outcome predictors were produced by scientific communities and administrative boards. However, the risk of childbirth related injury in women giving birth vaginally after a previous caesarean section was not clearly studied. Studies evaluating perineal injuries have conflicting results, while injuries to the higher levels of the pelvic floor have not yet been studied. In the first part of the presented research work, we retrospectively evaluated perineum and anal sphincter injuries in women who delivered vaginally after a previous caesarean section. We compared the results with a group of primiparous women after vaginal delivery. We also monitored the presence of risk factors for pelvic floor injury, including the influence of the timing of the previous caesarean section. It has been proven that women, who delivered vaginally after a previous caesarean section have significantly shorter first stage of labor. There was no difference in the frequency of perineal including anal sphincter injuries in...
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Vascularity of Female Urethra in Correlation to Urinary Incontinence : Diagnostic Algorithms and Its Clinical Implications
Švabík, Kamil ; Martan, Alois (advisor) ; Halaška, Michael (referee) ; Adamík, Zdeněk (referee)
Introduction: Intrinsic and extrinsic urethral factors play a significant role in urinary continence mechanism in women. Urethral wall structure including inervation, perfusion of submucosal layer etc. is not clinically assessed despite its important role in urethral closure function. The association of incontinence and pelvic floor reconstructive surgery is well known. Every postoperative healing process is associated with factors of ischemia and neovascularisation. According those facts we would expect that the healing and scaring should involve intrinsic urethral mechanism. After reconstructive surgery Implants further increase scaring process. Methods: In our study we included patients with anterior compartment defect. We randomized patients into three interventional arms according the surgical approach and use of implants. Before and 3-5 month after the surgery we performed urodynamic studies and pelvic floor ultrasound examination, including Doppler for urethral perfusion assessment. Another early ultrasound scan was added forth day after surgery. We correlated ultrasound and urodynamic parameters. Results: We randomized 87 patients. We couldn't find any correlation between the morphologic changes and severity of incontinence. Methods for urethral perfusion assessment showed high inaccuracy...
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To determine the indication for the use of synthetic materials in pelvic floor reconstructive surgery.
El Haddad, Rachid ; Švabík, Kamil (advisor) ; Huser, Martin (referee) ; Kališ, Vladimír (referee)
Introduction: Pelvic organ prolapse is a major health problem affecting 50% of parous women over the age of 50. The lifetime risk for pelvic floor surgery for prolapse is likely to be between 10 and 20% and a large number of patients require repeat surgery for recurrence. Cochrane review showed that mesh use at the time of anterior repair reduce the risk of recurrence. In our first study we prospectively evaluate the impact of mesh insertion during anterior repair on sexual function and quality of life. Mesh insertion may be associated with significant and in some cases serious adverse events. To justify its use, it seems necessary to identify women at high risk of prolapse recurrence. There is evidence indicating that levator ani avulsion injury is closely associated with prolapse recurrence. The aim of our second and main study was to demonstrate in a prospective randomized way that levator avulsion may be used to identify patients at high risk for failed native tissue prolapse surgery. Methods: The first study prospectively evaluated with validated questionnaires the impact of mesh insertion on quality of life and sexual function. The second study is a single-center, prospective, randomized interventional trial of two standard surgical procedures for post-hysterectomy vaginal vault prolapse in...
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Vascularity of Female Urethra in Correlation to Urinary Incontinence : Diagnostic Algorithms and Its Clinical Implications
Švabík, Kamil ; Martan, Alois (advisor) ; Halaška, Michael (referee) ; Adamík, Zdeněk (referee)
Introduction: Intrinsic and extrinsic urethral factors play a significant role in urinary continence mechanism in women. Urethral wall structure including inervation, perfusion of submucosal layer etc. is not clinically assessed despite its important role in urethral closure function. The association of incontinence and pelvic floor reconstructive surgery is well known. Every postoperative healing process is associated with factors of ischemia and neovascularisation. According those facts we would expect that the healing and scaring should involve intrinsic urethral mechanism. After reconstructive surgery Implants further increase scaring process. Methods: In our study we included patients with anterior compartment defect. We randomized patients into three interventional arms according the surgical approach and use of implants. Before and 3-5 month after the surgery we performed urodynamic studies and pelvic floor ultrasound examination, including Doppler for urethral perfusion assessment. Another early ultrasound scan was added forth day after surgery. We correlated ultrasound and urodynamic parameters. Results: We randomized 87 patients. We couldn't find any correlation between the morphologic changes and severity of incontinence. Methods for urethral perfusion assessment showed high inaccuracy...
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