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Vulvar Anatomy

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21. Vulvar-Vaginal Reconstruction (Diagnosis)

fibers. In the nulliparous female, the sagittal dimension of both the vaginal introitus and the perineum is approximately 2 cm. An increase introitus:perineum ration may indicate perineal body disruption, especially in the nulliparous patient. Vulva surface anatomy. Superficial subcutaneous mons. The following image illustrates pertinent vulvar structures deep to the skin. Superficial perineal structures. Take special note of the following features: The perineum can be conveniently conceptualized (...) management of a patient who has sustained perineal trauma, except as necessary to achieve control of hemorrhage, until the patient is sufficiently stable to tolerate general or regional anesthesia. Previous References Propst AM, Thorp JM Jr. Traumatic vulvar hematomas: conservative versus surgical management. South Med J . 1998 Feb. 91(2):144-6. . DeLancey JOL. Surgical anatomy of the female pelvis. Rock JA, Jones HW III, eds. TeLinde's Operative Gynecology . 10th ed. Philadelphia: Lippincott Williams

2014 eMedicine.com

22. Benign Vulvar Lesions (Diagnosis)

Benign Vulvar Lesions (Diagnosis) Benign Vulvar Lesions: Overview, Etiology and Pathophysiology, Clinical History and Physical Findings Edition: No Results No Results Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMjY0NjQ4LW92ZXJ2aWV3 (...) processing > Benign Vulvar Lesions Updated: Apr 05, 2019 Author: Robert A Schwartz, MD, MPH; Chief Editor: Michel E Rivlin, MD Share Email Print Feedback Close Sections Sections Benign Vulvar Lesions Overview Overview In the last few years, interest in vulvar disease has greatly increased. However, the relevant material has been scattered throughout the literature of various specialties, including dermatology, genitourinary medicine, gynecology, and pathology. The spectrum of involved specialties

2014 eMedicine.com

23. Vulvar Lichen Sclerosus

" paper") may be present Last and contiguous anatomy distorted Clitoris and Labia minora may not be visible (buried in surrounding tissue) V. Labs: Biopsy Biopsy especially indicated if squamous cell hyperplasia present Risk of developing of the vulva is 5% in Also biopsy vulvar lesions that fail to heal with management (see below) VI. Differential Diagnosis See Squamous Cell Hyperplasia VII. Associated Conditions: Autoimmune Conditions (present in >20% of cases) or VIII. Management s Initial (first 2 (...) Vulvar Lichen Sclerosus Vulvar Lichen Sclerosus Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Vulvar Lichen Sclerosus Vulvar Lichen

2015 FP Notebook

24. Normal Vulvovaginal, Perineal, and Pelvic Anatomy with Reconstructive Considerations Full Text available with Trip Pro

Normal Vulvovaginal, Perineal, and Pelvic Anatomy with Reconstructive Considerations A thorough insight into the female genital anatomy is crucial for understanding and performing pelvic reconstructive procedures. The intimate relationship between the genitalia and the muscles, ligaments, and fascia that provide support is complex, but critical to restore during surgery for correction of prolapse or aesthetic reasons. The external female genitalia include the mons pubis, labia majora and minora (...) , clitoris, vestibule with glands, perineal body, and the muscles and fascia surrounding these structures. Through the perineal membrane and the perineal body, these superficial vulvar structures are structurally related to the deep pelvic muscle levator ani with its fascia. The levator ani forms the pelvic floor with the coccygeus muscle and provides vital support to all the pelvic organs and stability to the perineum. The internal female genital organs include the vagina, cervix, uterus, tubes

2011 Seminars in plastic surgery

25. The anterior Obturator Artery Perforator (aOAP) flap: Surgical anatomy and application of a method for vulvar reconstruction. (Abstract)

The anterior Obturator Artery Perforator (aOAP) flap: Surgical anatomy and application of a method for vulvar reconstruction. Vulvar reconstruction following oncologic resection is challenging. Some flaps used for reconstruction can show adverse characteristics such as excessive tissue bulk or increased distance to the defect. Region of the sulcus genitofemoralis is of thin and pliable tissue proximate to the vulva. Vasculature and suitability of that region used for vulvar reconstruction were (...) focused in this work.Vascular architecture of the region comprising the sulcus genitofemoralis was examined bilaterally on 10 female corpses (n = 20 specimens). In addition, tissue characteristics and suitability of that region to form a fasciocutaneous flap for vulvar reconstruction were anatomically examined and clinically proven.Vasculature of the sulcus genitofemoralis is reflected by either a musculocutaneous perforator (80%, 16/20) piercing the gracilis muscle or a septocutaneous perforator (20

2010 Gynecologic Oncology

26. Female Genital Cosmetic Surgery

are similar to, if notthesameas,thetraditionalanterior andposterior colporrhaphy) and marketing them as new cosmetic vaginal procedures is misleading. Background Female genital cosmetic surgery, when referred to in this CommitteeOpinion,isdefinedasthesurgicalalterationof the vulvovaginal anatomy intended for cosmesis in women who have no apparent structural or functional abnormality. Genital cosmetic surgery will not refer to procedures performed for clinical indications (eg, clini (...) sources, may drive women to seek surgical alteration (6). Women who explore cosmetic surgery often turn to internet searches. This is particularly important becausetheinternetmaybetheironlysourceofinformation (6). A systematic review of online content that promoted female genital cosmetic surgery found that sites that pro- moted cosmetic genital surgery regularly described the wide variation of normal vulvar appearance as unnatural or dis- eased and implied that variation beyond the prepubescent

2020 American College of Obstetricians and Gynecologists

27. ASTRO Guideline on Definitive and Postoperative Radiation Therapy for Basal and Squamous Cell Cancers of the Skin

are several related topics, including RT and systemic therapy in the setting of metastatic BCC and cSCC, dermatopathologic aspects of skin cancer diagnosis, nuances of surgical management and the technical details of radiation delivery for skin cancer. Additionally, this guideline does not pertain to the management of mucosal head and neck squamous cell carcinoma, vulvar, penile, or perianal skin carcinoma. Table 2. KQs in Population, Intervention, Comparator, Outcome (PICO) format KQ Population (...) selection among the various RT techniques can further enhance cosmetic and functional sparing. For example, orthovoltage beam or brachytherapy techniques are well-suited for especially sensitive ocular anatomy associated with medial canthus or eyelid lesions. 10,11,20 Surgical deformity of the nose and lips can lead to poor cosmesis and compromised function lending these sites to be particularly suitable for treatment with definitive RT. 9-11,21,22 Specialized radiation techniques (eg, surface

2020 American Society for Radiation Oncology

28. Canadian Urological Association guideline for the diagnosis, management, and surveillance of neurogenic lower urinary tract dysfunction

conversion to a suprapubic catheter in the setting of significant urethral damage (GOR A, LOE 3) and ideally before the urethra has been irreversibly dam- aged and there is a risk of stress incontinence. 62 Sexuality is adversely affected for 40–91% of patients with neurogenic bladder, 67 and incontinence is a significant contributing factor due to fear of leakage during intercourse, embarrassment, concerns about odours, dyspareunia from vulvar irritation, or dermatitis from chronic leakage. 68 Side

2019 Canadian Urological Association

29. Management of genitourinary syndrome of menopause in women with or at high risk for breast cancer: consensus recommendations from The North American Menopause Society and The International Society for the Study of Women’s Sexual Health

,orotherdermatopathology.During anexamination, thewoman andcliniciancanreviewareasof concern,and women can beeducatedregarding anatomy and instructed in the application of local therapies, using a hand mirror as needed. Assessment of breast cancer risk Identification of women at high risk for breast cancer may factor into shared decision-making regarding the use of local hormonetherapiesforGSM.Breastcancerriskisincreasedin women with a family history of breast cancer or a personal history of breast biopsy and in women (...) with the uterus in the upper vagina and potential for greater systemic absorp- tion); 68 and whether the estrogen is applied topically to the vulvar skin and/or vestibule versus the highly absorptive vaginal epithelium. Absorption also varies greatly by the condition of the vagina (atrophic vs estrogenized) and how long after application the assessment of absorption is deter- mined.Thethin,atrophicvaginaishighlyabsorptive,andthis diminisheswhentheepitheliumthickensinresponsetoestro- genization. 69 Without

2019 The North American Menopause Society

30. Oncologic imaging

Health. All Rights Reserved. 3 Pancreatic Cancer 72 Paraneoplastic Syndrome 74 Penile, Vaginal, and Vulvar Cancers 75 Prostate Cancer 77 Sarcoma of Bone and Soft Tissue 80 Thoracic Cancers – Pleura, Thymus, Heart and Mediastinum 83 Thyroid Cancer 85 Uterine Cancer 88 Codes 91 History 93 Oncologic Imaging Copyright © 2019. AIM Specialty Health. All Rights Reserved. 4 Description and Application of the Guidelines The AIM Clinical Appropriateness Guidelines (hereinafter “the AIM Clinical Appropriateness (...) Complications from prior fiberoptic colonoscopy o Diverticulitis with increased risk of perforation o Failed or incomplete fiberoptic colonoscopy of the entire colon, due to inability to pass the colonoscope proximally (may be secondary to obstructing neoplasm, spasm, redundant colon, altered anatomy or scarring from previous surgery, stricture, or extrinsic compression) o Increased sedation risk, such as chronic obstructive pulmonary disease or previous adverse reaction to anesthesia o Known colonic

2019 AIM Specialty Health

31. Chronic Pelvic Pain

cystitis. Urology, 2007. 70: 16. 153. Reissing, E.D., et al. Pelvic floor muscle functioning in women with vulvar vestibulitis syndrome. J Psychosom Obstet Gynaecol, 2005. 26: 107. 154. Nickel , J., et al. Management of men diagnosed with chronic prostatitis/chronic pelvic pain syndrome who have failed traditional management. Rev Urol, 2007. 9: 63. 155. Nickel, J.C., et al. Chronic Prostate Inflammation Predicts Symptom Progression in Patients with Chronic Prostatitis/Chronic Pelvic Pain. J Urol, 2017 (...) colpopexy: management of postoperative pudendal nerve entrapment. Obstet Gynecol, 1996. 88: 713. 218. Fisher, H.W., et al. Nerve injury locations during retropubic sling procedures. Int Urogynecol J, 2011. 22: 439. 219. Moszkowicz, D., et al. Where does pelvic nerve injury occur during rectal surgery for cancer? Colorectal Dis, 2011. 13: 1326. 220. Ashton-Miller, J.A., et al. Functional anatomy of the female pelvic floor. Ann N Y Acad Sci, 2007. 1101: 266. 221. Amarenco, G., et al. [Perineal neuropathy

2019 European Association of Urology

32. Urological Trauma

of Transvaginal Mesh for Pelvic Organ Prolapse and Stress Urinary Incontinence: Tips for Prevention, Recognition, and Management. Eur Urol Focus, 2016. 2: 260. 201. Inaba, K., et al. Prospective evaluation of the utility of routine postoperative cystogram after traumatic bladder injury. J Trauma Acute Care Surg, 2013. 75: 1019. 202. Latini, J.M., et al. SIU/ICUD Consultation On Urethral Strictures: Epidemiology, etiology, anatomy, and nomenclature of urethral stenoses, strictures, and pelvic fracture urethral (...) fracture urethral injuries. Urology, 2014. 83: S48. 214. Barratt, R.C., et al. Pelvic fracture urethral injury in males-mechanisms of injury, management options and outcomes. Transl Androl Urol, 2018. 7: S29. 215. Mundy, A.R., et al. Urethral trauma. Part I: introduction, history, anatomy, pathology, assessment and emergency management. BJU Int, 2011. 108: 310. 216. Mundy, A.R., et al. Pelvic fracture-related injuries of the bladder neck and prostate: their nature, cause and management. BJU Int, 2010

2019 European Association of Urology

33. Anal Squamous Cell Cancers

in- tercourse, 12 and a history of cervical, vaginal, or vulvar cancer. 13 Risk factors related to immunity include a di- agnosis of HIV, 14 autoimmune disorders such as lupus and sarcoidosis, 15 and being the recipient of a solid organ transplant. 16 Female sex 3 and cigarette smoking 17 are also associated with developing anal malignancies. ANATOMIC CONSIDERATIONS AND TERMINOLOGY The management of anal cancers requires a multidisci- plinary approach, and the unfamiliarity of nonsurgical disciplines (...) with anorectal anatomy can create ambiguity in describing the location and the clinical stage of anal cancers across disciplines. The anal canal, as viewed by colorectal surgeons, is ˜4 to 5 cm in length beginning at the distal rectum, where the mucosa blends into the anal transitional zone (ATZ) epithelium, which then transi- tions to nonkeratinized squamous epithelium as it further transitions into keratinized perianal skin at the anal verge. An ATZ, located several millimeters proximal to the den- tate

2018 American Society of Colon and Rectal Surgeons

34. Lichen Sclerosus

(scleros* or atrophi* or albu* or scleureu* or sclero-atrophi* or vulva* or genita*)).ab,ti. 3. "white spot* diseas*".ab,ti. 4. exp Vulvar Lichen Sclerosus/ 5. "kraurosi* vulva*".ab,ti. 6. (vulva* and (atroph* or dystroph*)).ab,ti. 7. exp Balanitis Xerotica Obliterans/ 8. balaniti* xerotic* oblitera*.ab,ti. 9. "kraurosi* peni*".ab,ti. 10. 1 or 2 or 3 or 4 or 5 or 6 or 7 or 8 or 9 11. Randomized Controlled Trials as Topic/ 12. randomized controlled trial/ 13. Random Allocation/ 14. Double-Blind Method (...) (blind$3 or mask$3)).tw. 29. Placebos/ 30. placebo$.tw. 31. randomly allocated.tw. 32. (allocated adj2 random$).tw. 33. 27 or 28 or 29 or 30 or 31 or 32 34. 26 or 33 35. case report.tw. 36. letter/ 37. historical article/ 38. 35 or 36 or 37 39. 34 not 38 40. 10 and 39 MEDLINE search for case reports 1. exp Lichen Sclerosus et Atrophicus/ 2. (lichen adj3 (scleros* or atrophi* or albu* or scleureu* or sclero-atrophi* or vulva* or genita*)).ab,ti. 3. "white spot* diseas*".ab,ti. 4. exp Vulvar Lichen

2018 European Dermatology Forum

35. Urological Trauma

of Transvaginal Mesh for Pelvic Organ Prolapse and Stress Urinary Incontinence: Tips for Prevention, Recognition, and Management. Eur Urol Focus, 2016. 2: 260. 201. Inaba, K., et al. Prospective evaluation of the utility of routine postoperative cystogram after traumatic bladder injury. J Trauma Acute Care Surg, 2013. 75: 1019. 202. Latini, J.M., et al. SIU/ICUD Consultation On Urethral Strictures: Epidemiology, etiology, anatomy, and nomenclature of urethral stenoses, strictures, and pelvic fracture urethral (...) fracture urethral injuries. Urology, 2014. 83: S48. 214. Barratt, R.C., et al. Pelvic fracture urethral injury in males-mechanisms of injury, management options and outcomes. Transl Androl Urol, 2018. 7: S29. 215. Mundy, A.R., et al. Urethral trauma. Part I: introduction, history, anatomy, pathology, assessment and emergency management. BJU Int, 2011. 108: 310. 216. Mundy, A.R., et al. Pelvic fracture-related injuries of the bladder neck and prostate: their nature, cause and management. BJU Int, 2010

2018 European Association of Urology

36. The Utility of and Indications for Routine Pelvic Examination

are needed. Potential Benefits of the Screening Pelvic Examination for Asymptomatic Women Based on expert opinion, potential benefits of the pelvic examination include early detection of treatable gynecologic conditions before symptoms occurring (eg, vulvar or vaginal cancer), as well as incidental findings such as dermatologic changes and foreign bodies. Additionally, screening pelvic examinations in the context of a well-woman visit ( ) may allow gynecologists to explain a patient’s anatomy, reassure

2018 American College of Obstetricians and Gynecologists

37. Chronic Pelvic Pain

cystitis. Urology, 2007. 70: 16. 153. Reissing, E.D., et al. Pelvic floor muscle functioning in women with vulvar vestibulitis syndrome. J Psychosom Obstet Gynaecol, 2005. 26: 107. 154. Nickel , J., et al. Management of men diagnosed with chronic prostatitis/chronic pelvic pain syndrome who have failed traditional management. Rev Urol, 2007. 9: 63. 155. Nickel, J.C., et al. Chronic Prostate Inflammation Predicts Symptom Progression in Patients with Chronic Prostatitis/Chronic Pelvic Pain. J Urol, 2017 (...) colpopexy: management of postoperative pudendal nerve entrapment. Obstet Gynecol, 1996. 88: 713. 218. Fisher, H.W., et al. Nerve injury locations during retropubic sling procedures. Int Urogynecol J, 2011. 22: 439. 219. Moszkowicz, D., et al. Where does pelvic nerve injury occur during rectal surgery for cancer? Colorectal Dis, 2011. 13: 1326. 220. Ashton-Miller, J.A., et al. Functional anatomy of the female pelvic floor. Ann N Y Acad Sci, 2007. 1101: 266. 221. Amarenco, G., et al. [Perineal neuropathy

2018 European Association of Urology

39. Clinical Appropriateness Guidelines: Radiation Oncology Brachytherapy, intensity modulated radiation therapy (IMRT), stereotactic body radiation therapy (SBRT) and stereotactic radiosurgery (SRS) treatment guidelines

treatment to a higher dose, the IGRT group was noted to have similar genitourinary and gastrointestinal toxicities. Pre-treatment corrective left-right, anteroposterior and superoinferior shifts were required in 15%, 6% and 19% of cases respectively supporting the use of pre- treatment imaging. The ACR-ASTRO practice parameter for IGRT indicates that “when the target is not clearly visible and bony anatomy is not sufficient for adequate target alignment, fiducial markers may be needed.” For soft tissue (...) bony anatomy based on intraprostatic gold markers and electronic portal imaging. Int J Radiat Oncol Biol Phys. 2005;63(3):800-811. 31. Shah A, Aird E, Shekhdar J. Contribution to normal tissue dose from concomitant radiation for two common kV-CBCT systems and one MVCT system used in radiotherapy. Radiother Oncol. 2012;105(1):139-144. 32. Singh J, Greer PB, White MA, et. al. Treatment-related morbidity in prostate cancer: A comparison of 3-dimensional conformal radiation therapy with and without

2018 AIM Specialty Health

40. Appropriate Use Criteria: Imaging of the Chest

features is present: ¦ Lymphatic or venous invasion ¦ Lymph node involvement ¦ Perineural invasion ¦ Poorly differentiated tumor ¦ T4 tumor ¦ Associated with bowel obstruction ¦ Close, indeterminate or positive margins ¦ Fewer than 12 nodes examined at surgery ¦ Localized perforation ? Gynecologic malignancies ? Surveillance imaging in patients with previously treated gynecologic malignancies including ovarian, endometrial, cervical, vaginal or vulvar cancer (Note: This exclusion does not apply (...) al. Atrial fibrillation: multi-detector row CT of pulmonary vein anatomy prior to radiofrequency catheter ablation–initial experience. Radiology. 2005; 234(3): 702-709. 33. Kanne JP, Jensen LE, Mohammed TL, et al.; American College of Radiology Expert Panel on Thoracic Imaging. ACR appropriateness Criteria® radiographically detected solitary pulmonary nodule. J Thorac Imaging. 2013;28(1):W1-W3. 34. Kazerooni EA. High-resolution CT of the lungs. AJR Am J Roentgenol. 2001;177(3):501-519. 35

2018 AIM Specialty Health

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