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Vulvar Anatomy

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121. Surgical Treatment of Vaginal Cancer (Treatment)

approaches to the treatment of upper and lower vaginal cancer. According to the International Federation of Gynecology and Obstetrics (FIGO), a vaginal lesion involving the external os of the cervix should be considered and treated as such; a tumor involving both the vulva and the vagina should be considered vulvar cancer. About 80% of vaginal cancers are metastatic, primarily from the cervix or endometrium. Metastatic cancer from the vulva, ovaries, choriocarcinoma, rectosigmoid, and bladder are less (...) to prevent disease from HPV type 6, 11, 16, 18, 31, 33, 45, 52 and 58. Patient education For patient education information, see the and the , as well as , , , and . Relevant Anatomy The vagina is located in the true pelvis, which also contains the rest of the internal genital tract, the rectosigmoid, the bladder, the proximal urethra, and the pelvic portions of the ureters. The pelvic organs are partially covered by the peritoneum. The endopelvic fascia covers these organs and forms their supporting

2014 eMedicine.com

122. Surgical Management of Mullerian Duct Anomalies (Treatment)

informed consent discussion with her gynecologic care provider and her respective parent(s) or guardian(s). Primary vaginal dilation is successful for more than 90–96% of patients, Referrals to centers with expertise should be offered regardless of the surgical technique chosen. The surgeon must be experienced with the procedure because the initial procedure is more likely to succeed than follow-up procedures. Although vulvar and vaginal intraepithelial neoplasia are possible, routine cytology testing (...) of other tissues have been used as the graft source. Human amnion, not stripped from the chorion, has been used as a graft for vaginoplasties. [ ] Transposition flaps were described in 2 reports. In 1 method, a de-epithelialized vulvar transposition flap was used as the graft, and in the other, a pudendal thigh fasciocutaneous flap was described. Both authors reported good cosmetic and functional results. [ , ] Autologous buccal mucosa has also been used as a graft source. These approaches harvested

2014 eMedicine.com

123. Nephrolithiasis: Acute Renal Colic (Overview)

Nephrolithiasis: Acute Renal Colic (Overview) Nephrolithiasis: Practice Essentials, Background, Anatomy 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=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvNDM3MDk2LW92ZXJ2aWV3 processing > Nephrolithiasis Updated: Jun (...) and characteristics of pain in nephrolithiasis include the following: Stones obstructing ureteropelvic junction: Mild to severe deep flank pain without radiation to the groin; irritative voiding symptoms (eg, frequency, dysuria); suprapubic pain, urinary frequency/urgency, dysuria, stranguria, bowel symptoms Stones within ureter: Abrupt, severe, colicky pain in the flank and ipsilateral lower abdomen; radiation to testicles or vulvar area; intense nausea with or without vomiting Upper ureteral stones: Radiate

2014 eMedicine.com

124. Nephrolithiasis (Overview)

Nephrolithiasis (Overview) Nephrolithiasis: Practice Essentials, Background, Anatomy 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=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvNDM3MDk2LW92ZXJ2aWV3 processing > Nephrolithiasis Updated: Jun 21, 2018 Author (...) in nephrolithiasis include the following: Stones obstructing ureteropelvic junction: Mild to severe deep flank pain without radiation to the groin; irritative voiding symptoms (eg, frequency, dysuria); suprapubic pain, urinary frequency/urgency, dysuria, stranguria, bowel symptoms Stones within ureter: Abrupt, severe, colicky pain in the flank and ipsilateral lower abdomen; radiation to testicles or vulvar area; intense nausea with or without vomiting Upper ureteral stones: Radiate to flank or lumbar areas

2014 eMedicine.com

125. Imperforate Hymen (Overview)

fimbriated, and the mucosal surfaces (ie, introitus, fossa navicularis, vaginal vestibule) are pale pink. Next: Problem Imperforate hymen has been diagnosed with prenatal ultrasound documentation of bladder outlet obstruction due to hydrocolpos or mucocolpos. However, in spite of the recommendations for inspection of the external genitalia during the neonatal and early childhood period, variations in hymenal anatomy commonly escape diagnosis until the time of menarche. See the image below. Imperforate (...) ) Previous Next: Epidemiology Frequency Imperforate hymen is likely the most frequent obstructive anomaly of the female genital tract, but estimates of its frequency vary from 1 case per 1000 population to 1 case per 10,000 population. A population-based study estimated the frequency at 0.5 case per 1000 women (95% confidence interval, 0.3-0.7). [ ] Heger et al examined 147 premenarchal girls with a mean age of 63 months to collect normative data on genital anatomy; an imperforate hymen was found in only

2014 eMedicine.com

126. Fournier Gangrene (Overview)

Fournier Gangrene (Overview) Fournier Gangrene: Practice Essentials, Background, Anatomy 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=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMjAyODg5OS1vdmVydmlldw== processing > Fournier Gangrene Updated: Jan 10, 2018 (...) lover), placement of foreign bodies such as beans within the urethra, and excessive intercourse in diabetic and alcoholic persons. He calls upon physicians to be steadfast in obtaining confession from patients of “obscene practices.” Previous Next: Anatomy The complex anatomy of the male external genitalia influences the initiation and progression of Fournier gangrene. This infectious process involves the superficial and deep fascial planes of the genitalia. As the microorganisms responsible

2014 eMedicine.com

127. Dermatologic Diseases of the Male Genitalia: Nonmalignant (Overview)

Dermatologic Diseases of the Male Genitalia: Nonmalignant (Overview) Nonmalignant Dermatologic Diseases of the Male Genitalia: Introduction, Definition of Terms, and Anatomy, Trichomycosis and Folliculitis, Balanoposthitis, Balanitis, and Candidiasis 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=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvNDU1MDIxLW92ZXJ2aWV3 processing > Nonmalignant Dermatologic Diseases of the Male Genitalia Updated: Feb 11, 2017 Author: Douglas C Parker, MD, DDS; Chief Editor: Edward David Kim, MD, FACS Share Email Print Feedback Close Sections Sections Nonmalignant Dermatologic Diseases of the Male Genitalia Introduction, Definition of Terms, and Anatomy Nonmalignant lesions account for most dermatologic disorders seen by urologists. For most

2014 eMedicine.com

128. Uterine Prolapse (Overview)

are available. When planning the appropriate approach, the surgeon must consider operative risk, coital activity, and vaginal canal anatomy. The following list illustrates variables that must be considered. Important considerations for nonsurgical or surgical decision making See the list below: Medical condition and age Severity of symptoms Patient's choice (ie, surgery or no surgery) Patient's suitability for surgery Presence of other pelvic conditions requiring simultaneous treatment, including urinary (...) or fecal incontinence Presence or absence of urethral hypermobility Presence or absence of pelvic floor neuropathy History of previous pelvic surgery Previous Next: Relevant Anatomy Knowledge of the anatomy of the pelvis is essential to understanding prolapse. Teleologic reasoning aids in the understanding of POP. The pelvic floor evolved in primates, particularly humans, who as bipeds, spend most of their waking hours in the upright position. As the name suggests, the floor of the pelvis is the lowest

2014 eMedicine.com

129. The Role of Sentinel Node Biopsy in Skin Cancer (Overview)

, vulvar carcinoma, penile cancer, pediatric soft tissue sarcoma, and clear cell sarcoma (melanoma of the soft parts). Previous Next: Relevant Anatomy The concept of sentinel lymph node biopsy is that a primary or sentinel lymph node (or nodes) exists through which tumor cells from a primary tumor in a particular location first must travel, via afferent lymphatics, to spread to a particular regional lymph node basin. The technique is well suited for application to cutaneous malignancies because (...) . Diagnosis and treatment of interval sentinel lymph nodes in patients with cutaneous melanoma. Plast Reconstr Surg . 2007 Mar. 119(3):907-13. . Thompson JF, Uren RF, Shaw HM, et al. Location of sentinel lymph nodes in patients with cutaneous melanoma: new insights into lymphatic anatomy. J Am Coll Surg . 1999 Aug. 189(2):195-204. . Scarsbrook AF, Ganeshan A, Bradley KM. Pearls and pitfalls of radionuclide imaging of the lymphatic system. Part 1: sentinel node lymphoscintigraphy in malignant melanoma. Br

2014 eMedicine.com

130. Radiation Therapy in Gynecology (Follow-up)

to the pelvic sidewall and/or causing hydronephrosis or a nonfunctioning kidney Stage IVA - Invasion of the bladder or rectal mucosa Stage IVB - Distant metastasis (the para-aortic lymph nodes are considered a distant metastatic site) Vulvar cancer The current FIGO/AJCC staging guidelines for vulvar cancer are as follows: Stage IA - Tumor confined to the vulva or perineum and 2 cm or smaller with stromal invasion 1 mm or less, negative nodes Stage IB – Tumor confined to the vulva or perineum, larger than 2 (...) have significantly higher rates of regional lymph node metastases, locoregional and distant-site relapse, and poor outcome. Because direct extension of tumor into adjacent structures limits the ability of surgery to gain clear surgical margins, and the presence of the uterus is critical for the anatomy of brachytherapy insertion in this setting, primary chemoradiotherapy is generally indicated for the management of stage IIB-IVA locally advanced cervical cancer. Tumoral resection with anterior

2014 eMedicine.com

131. Benign Cervical Lesions (Overview)

Benign Cervical Lesions (Overview) Benign Cervical Lesions: Embryology, Anatomy, Physiology 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=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMjY0OTY2LW92ZXJ2aWV3 processing > Benign Cervical Lesions Updated: Oct 08 (...) , sinovaginal bulb). Through a process of squamous metaplasia, the vagina and a variable portion of the ectocervix become covered with squamous epithelium. This process is complete by the fifth month of pregnancy. Next: Anatomy The cervix (Latin for neck) is the inferior part of the uterus protruding into the vagina. Gross anatomy The cervix measures 2.5-3 cm in diameter and 3-5 cm in length. The normal anatomic position of the cervix is angulated slightly downward and backward. Inferiorly, the cervix

2014 eMedicine.com

132. Nonneoplastic Epithelial Disorders of the Vulva (Follow-up)

Nonneoplastic Epithelial Disorders of the Vulva (Follow-up) 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

2014 eMedicine.com

133. Normal and Abnormal Puerperium (Follow-up)

to the nonpregnant state. An overview of the relevant anatomy and physiology in the postpartum period follows. Uterus The pregnant term uterus (not including baby, placenta, fluids, etc) weighs approximately 1000 g. In the 6 weeks following delivery, the uterus recedes to a weight of 50-100 g. Immediately postpartum, the uterine fundus is palpable at or near the level of the maternal umbilicus. Thereafter, most of the reduction in size and weight occurs in the first 2 weeks, at which time the uterus has shrunk (...) sphincter complex as well as the anal epithelium. Any deep perineal laceration noted after a delivery warrants a thorough evaluation including a digital rectal exam to improve the diagnosis of OASIS. Approximately 4% of women have a clinically recognized OASIS immediately after time of vaginal delivery . [ ] Other tears after childbirth include periclitoral, periurethral, and labial lacerations; these should only be repaired to achieve hemostasis or to correct distorted anatomy. Additionally

2014 eMedicine.com

134. Perineal Reconstruction

and pelvic defect. [ ] In 1976, McCraw et al described the original reconstruction with the gracilis myocutaneous flap. [ ] Previous Next: Relevant Anatomy The major blood supply to the gracilis myocutaneous or gracilis muscle flap is derived from the medial femoral circumflex artery. This artery enters the muscle approximately 8-10 cm below the inguinal ligament. Additional minor perforators originate proximally from the obturator artery and may supply a short gracilis flap. Occasionally one or two (...) of a pedicled deep inferior epigastric perforator flap for burn scar contracture of the groin: case report. J Reconstr Microsurg . 2005 Oct. 21(7):447-50; discussion 451-2. . Muneuchi G, Ohno M, Shiota A, et al. Deep inferior epigastric perforator (DIEP) flap for vulvar reconstruction after radical vulvectomy: a less invasive and simple procedure utilizing an abdominal incision wound. Ann Plast Surg . 2005 Oct. 55(4):427-9. . Blondeel PN, Van Landuyt K, Hamdi M, Monstrey SJ. Soft tissue reconstruction

2014 eMedicine Surgery

135. Vulvovaginitis (Treatment)

Vulvovaginitis (Treatment) Vulvovaginitis: Practice Essentials, Background, Anatomy 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=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMjE4ODkzMS1vdmVydmlldw== processing > Vulvovaginitis Updated: Jan 19, 2018 Author (...) : Jill M Krapf, MD, FACOG; Chief Editor: Christine Isaacs, MD Share Email Print Feedback Close Sections Sections Vulvovaginitis Overview Practice Essentials Vulvovaginitis is a general term referring to many types of vaginal infection, although this article focuses on the following disorders, which affect the vulvar region: Vulvovaginal candidiasis Atrophic vaginitis Vulvar vestibulitis Contact dermatitis Signs and symptoms Acute vulvovaginal candidiasis Vulvar pruritus and burning - Primary symptoms

2014 eMedicine Emergency Medicine

136. Skin, Benign Skin Lesions

specific exterior findings. Understanding of histiologic terms requires knowledge of the anatomical layout of skin and the associated cells and extracellular matrix content that populate each layer. (For more information, see . Also see the illustration below of skin anatomy). Anatomy of the skin. To facilitate accurate communication of the description of skin lesions between medical personnel, a multitude of descriptive terms have been developed. The terminology can largely be categorized as gross (...) on this topic. Bowen disease and Bowenoid papulosis Bowen disease is considered a synonym for squamous cell carcinoma in situ . In contrast, bowenoid papulosis is a term used when histologic changes of squamous cell carcinoma are found within genital warts. The term bowenoid papulosis, and not Bowen disease or squamous cell in situ, for these cases is generally preferred since the papules typically follow a benign course. In bowenoid papulosis, itching is a common symptom. With vulvar involvement, the labia

2014 eMedicine Surgery

137. Skin Malignancies, Merkel Cell Carcinoma and Rare Appendageal Tumors

that complete excision significantly improved overall survival. [ ] In addition, tumor size and location greatly impacted the outcome of surgical excision; a worse prognosis has been associated with primary tumors larger than 2 cm and located in the perianal and vulvar regions. The high rate of local recurrence even after surgical excision (~50%) argues strongly for regional lymphadenectomy. [ ] In a limited number of cases, Smith and colleagues demonstrated that patients with local and regional control (...) on individual patients, but they have not been studied rigorously in clinical trials. [ , ] Radiotherapy for liposarcoma of the vulva was reported effective by Yokouchi in 2000. [ ] Randomized trials need to be performed to define the role of radiation. Previous Next: Adnexal Tumors Anatomy Although often classified together as sweat glands, the apocrine and eccrine glands are 2 distinctive types of glands, differing in embryological origin and function. Apocrine glands are derived from the pilosebaceous

2014 eMedicine Surgery

138. Surgical Treatment of Vaginal Cancer (Follow-up)

approaches to the treatment of upper and lower vaginal cancer. According to the International Federation of Gynecology and Obstetrics (FIGO), a vaginal lesion involving the external os of the cervix should be considered and treated as such; a tumor involving both the vulva and the vagina should be considered vulvar cancer. About 80% of vaginal cancers are metastatic, primarily from the cervix or endometrium. Metastatic cancer from the vulva, ovaries, choriocarcinoma, rectosigmoid, and bladder are less (...) to prevent disease from HPV type 6, 11, 16, 18, 31, 33, 45, 52 and 58. Patient education For patient education information, see the and the , as well as , , , and . Relevant Anatomy The vagina is located in the true pelvis, which also contains the rest of the internal genital tract, the rectosigmoid, the bladder, the proximal urethra, and the pelvic portions of the ureters. The pelvic organs are partially covered by the peritoneum. The endopelvic fascia covers these organs and forms their supporting

2014 eMedicine.com

139. Surgical Management of Mullerian Duct Anomalies (Follow-up)

informed consent discussion with her gynecologic care provider and her respective parent(s) or guardian(s). Primary vaginal dilation is successful for more than 90–96% of patients, Referrals to centers with expertise should be offered regardless of the surgical technique chosen. The surgeon must be experienced with the procedure because the initial procedure is more likely to succeed than follow-up procedures. Although vulvar and vaginal intraepithelial neoplasia are possible, routine cytology testing (...) of other tissues have been used as the graft source. Human amnion, not stripped from the chorion, has been used as a graft for vaginoplasties. [ ] Transposition flaps were described in 2 reports. In 1 method, a de-epithelialized vulvar transposition flap was used as the graft, and in the other, a pudendal thigh fasciocutaneous flap was described. Both authors reported good cosmetic and functional results. [ , ] Autologous buccal mucosa has also been used as a graft source. These approaches harvested

2014 eMedicine.com

140. Dermatologic Diseases of the Male Genitalia: Nonmalignant (Follow-up)

Dermatologic Diseases of the Male Genitalia: Nonmalignant (Follow-up) Nonmalignant Dermatologic Diseases of the Male Genitalia: Introduction, Definition of Terms, and Anatomy, Trichomycosis and Folliculitis, Balanoposthitis, Balanitis, and Candidiasis 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=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvNDU1MDIxLW92ZXJ2aWV3 processing > Nonmalignant Dermatologic Diseases of the Male Genitalia Updated: Feb 11, 2017 Author: Douglas C Parker, MD, DDS; Chief Editor: Edward David Kim, MD, FACS Share Email Print Feedback Close Sections Sections Nonmalignant Dermatologic Diseases of the Male Genitalia Introduction, Definition of Terms, and Anatomy Nonmalignant lesions account for most dermatologic disorders seen

2014 eMedicine.com

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