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4. Propofol Versus Dexmedetomidine for Conscious Sedation During Vaginal Hysterectomy With Pre-emptive Local Anesthesia: A Prospective Cohort Study.

Author

HADZILIA, SOFIA, GRIGORIADIS, THEMOS, PRODROMIDOU, ANASTASIA, STAMATAKIS, EMMANOUIL, PAPADOPOULOU, DIMITRA, ZACHARAKIS, DIMITRIOS, ATHANASIOU, STAVROS, and VALSAMIDIS, DIMITRIOS

Abstract

Background/Aim: Hysterectomy is the most frequent gynecological surgery. Vaginal hysterectomy (VH) seems to be related to favorable perioperative outcomes compared to abdominal or laparoscopic approaches. As the population ages, anesthesia that is safer for the elderly, such as local anesthesia (LA) with conscious sedation, is gaining popularity and is related to favorable outcomes in patients’ recovery compared to general or regional anesthesia. We aimed to evaluate the efficacy of dexmedetomidine versus propofol for women undergoing VH for uterine prolapse under LA and conscious sedation. Patients and Methods: A prospective study on 40 women with uterine prolapse stage ≥3 who had VH under LA with conscious sedation under either dexmedetomidine (n=20) or propofol (n=20) was performed. A standardized surgical approach with continuous hemodynamic monitoring and sedation assessment using the Ramsay Sedation Scale (RSS) was conducted. The primary endpoint of the study was to determine the percentage of patients receiving intraoperative fentanyl. Results: Analysis of outcomes demonstrated a significant reduction in the proportion of patients requiring intraoperative rescue fentanyl (35% vs. 5%, respectively, p=0.04) and in postoperative pain scores, with more patients achieving an optimal RSS score of 3 in the dexmedetomidine group. Conclusion: Based on the findings of the present study, dexmedetomidine offered superior analgesia and patient comfort compared to propofol, suggesting a favorable anesthetic profile for VH under LA. [ABSTRACT FROM AUTHOR]

Published
2024
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16. CO 2 Laser versus Sham Control for the Management of Genitourinary Syndrome of Menopause: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Author

Prodromidou, Anastasia, Zacharakis, Dimitrios, Athanasiou, Stavros, Kathopoulis, Nikolaos, Varthaliti, Antonia, Douligeris, Athanasios, Michala, Lina, Athanasiou, Veatriki, Salvatore, Stefano, and Grigoriadis, Themos

Subjects
*GENITOURINARY diseases, *RANDOMIZED controlled trials, *CARBON dioxide, *LASERS, *VAGINAL dryness, *LASER therapy
Abstract

In the context of the menopausal transition, genitourinary syndrome of menopause (GSM) refers to a range of genitourinary symptoms, from vaginal dryness to dysuria and urinary urgency. While hormonal treatments are standard, their associated side effects have driven the exploration of alternatives like vaginal CO2 laser. We aimed to evaluate the randomized controlled trials (RCTs) comparing vaginal CO2 laser treatment for GSM to sham controls. This systematic review sourced four electronic databases until June 2023. The analysis incorporated seven RCTs with 407 women. The CO2 laser and sham control were comparable for most parameters, including the female sexual function index (FSFI) and visual analogue scale (VAS) for dyspareunia, vaginal health index, pH, and patient satisfaction. However, the CO2 laser group showed significant improvement in the vaginal assessment scale for GSM symptoms. Sensitivity analyses revealed that parameters like FSFI showed significant differences in favor of CO2 laser group upon the exclusion of specific studies. In conclusion, vaginal CO2 laser therapy emerges as a promising alternative for GSM management, especially for most bothersome GSM symptoms; however, the need for further well-designed RCTs remains to validate its broad safety and efficacy. [ABSTRACT FROM AUTHOR]

Published
2023
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38. Pelvic floor reconstructive surgery under local anesthesia: A systematic review and meta-analysis

Author

Zacharakis, Dimitrios Prodromidou, Anastasia Douligeris, Athanasios Hadzilia, Sofia Kathopoulis, Nikolaos Athanasiou, Stavros Grigoriadis, Themos

Abstract

Aims The decision on the appropriate type of anesthesia for pelvic floor repair depends on a variety of factors including patients’ age, performance status, comorbidities, cost-effectiveness and personal preferences. We aim to review the literature on urogynecological procedures performed under local anesthesia (LA). Methods A systematic search of four electronic databases was conducted for articles published up to May 2020. Studies reporting outcomes of women who underwent pelvic floor reconstructive surgery under LA with or without sedation, were considered eligible. Results Nineteen studies (14 noncomparative and 5 comparative), including 1626 cases of urogynecological procedures under LA were recruited. Meta-analysis revealed significantly lower mean pain scores in LA group compared to general-regional anesthesia one (GA/RA) at both 4-6 h and 8-18 h postoperatively (160 patients; mean difference [MD], -1.70; 95% confidence interval [CI]: -3.12, -0.28; p = 0.02 and 160 patients; MD, -0.72; 95% CI: -1.17, 0.27; p = 0.002, respectively). Pain scores at >24 h did not differ among the two groups (160 patients; MD, -0.28; 95% CI: -0.60-0.05; p = 0.10). Intra- and postoperatively morphine use was not different among patients who received LA and GA during prolapse surgery while nausea rates were significantly lower in LA group compared to RA group 8 h postoperatively. Conclusions LA with or without sedation represents a safe and efficient alternative anesthetic technique for urogynecological procedures with improved pain scores in up to 18 h postoperatively especially in patients who underwent surgery for SUI. LA is feasible and could be offered to patients undergoing pelvic floor surgery allowing a prompt postoperative recovery.

Published
2021

40. Leiomyoma originating from left round ligament presents as symptomatic inguinal hernia

Author

Kypriotis, Konstantinos Kathopoulis, Nikolaos Tsiriva, Maria and Zacharakis, Dimitrios Chatzipapas, Ioannis Protopapas, Athanasios

Subjects
body regions, stomatognathic diseases, surgical procedures, operative, musculoskeletal system
Abstract

Leiomyomas may develop at extra-uterine locations and pose diagnostic dile mmas. This is a case of a fibroma originating from the left round ligament presenting as a symptomatic inguinal hernia.

Published
2021

41. The Use of Platelet-rich Plasma as a Novel Nonsurgical Treatment of the Female Stress Urinary Incontinence: A Prospective Pilot Study

Author

Athanasiou, Stavros Kalantzis, Christos Zacharakis, Dimitrios and Kathopoulis, Nikolaos Pontikaki, Artemis Grigoriadis, Themistoklis

Abstract

Objectives The aim of the study was to evaluate the efficacy and safety of platelet-rich plasma (PRP) for the treatment of stress urinary incontinence (SUI). Methods This was a prospective observational pilot study conducted in a tertiary referral unit, enrolling women with SUI booked for SUI surgery. A total of 20 consecutive women met the inclusion criteria and attended all follow-ups. All participants underwent 2 PRP injections into the lower one third of the anterior vaginal wall at 4- to 6-week intervals. At baseline, they underwent urodynamic studies, a 1-hour pad test, and completed the International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms and King’s Health Questionnaire. At follow-up visits (1, 3, and 6 months), patients underwent the 1-hour pad test and completed the King’s Health Questionnaire, International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms, and Patient Global Impression Scale of Improvement. Primary outcome was to evaluate posttreatment SUI. Secondary outcomes included assessment of patient-reported questionnaires, assessment of urine loss (1-hour pad test), and the level of discomfort during injections (visual analog scale score). Statistical analysis was performed before PRP and 1, 3, and 6 months after the last treatment. Results A significant improvement in SUI symptoms was observed 3 months after treatment with a further improvement at 6 months. A mean reduction of 50.2% in urine loss was observed in the 1-hour pad test. At the 6-month follow-up, 80.0% of women reported to be at least improved. No adverse effects were observed. Conclusions Platelet-rich plasma injections were both effective and safe at least in the short term and could be offered as an alternative outpatient procedure for the treatment of SUI. However, these encouraging findings warrant further investigation with randomized controlled trials.

Published
2021

45. The Emerging Role on the Use of Platelet-Rich Plasma Products in the Management of Urogynaecological Disorders.

Author

Prodromidou, Anastasia, Zacharakis, Dimitrios, Athanasiou, Stavros, Protopapas, Athanasios, Michala, Lina, Kathopoulis, Nikolaos, and Grigoriadis, Themos

Abstract

Background : The regenerative efficacy of platelet-derived products has been recently investigated in the treatment of pelvic floor disorders (PFDs). We aimed to synthesize the current evidence of platelet-rich plasma (PRP) products used in urogynaecological disorders including vaginal atrophy, pelvic organ prolapse (POP), urinary incontinence, vaginal fistulas and vaginal mesh exposure. Methods : A meticulous search of the currently available literature on the use of PRP for the management of PFDs was performed using 3 electronic databases. Results : PRP could be a feasible alternative modality for the management of vaginal atrophy with favourable outcomes in vaginal atrophy parameters and patients' satisfaction, especially when hormone therapy is contraindicated. In patients with POP, an increase in collagen concentration after PRP application was observed while the use of PRP resulted in improvement of stress urinary incontinence symptoms. A considerable proportion of vesicovaginal fistulas were treated after application of PRP-based injections. Conclusions : There is only limited evidence of the use of PRP for PFDs. Platelet-rich plasma appears to be a promising, easy to apply, cost-effective and feasible alternative therapeutic modality for the management of various urogynaecological disorders. Future randomized trials are needed to confirm the efficacy of PRP in the treatment of urogynaecological disorders. [ABSTRACT FROM AUTHOR]

Published
2022
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46. Misoprostol vs vasopressin as a single hemostatic agent in laparoscopic myomectomy: Comparable, or just better than nothing?

Author

Protopapas, Athanasios, primary, Kathopoulis, Nikolaos, additional, Chatzipapas, Ioannis, additional, Athanasiou, Stavros, additional, Grigoriadis, Themistoklis, additional, Samartzis, Konstantinos, additional, Kypriotis, Konstantinos, additional, Vlachos, Dimitrios‐Eythymios, additional, Zacharakis, Dimitrios, additional, and Loutradis, Dimitrios, additional

Published
2020
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