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Papers by Smita Rajshekhar
Obstetrics, Gynaecology & Reproductive Medicine, Nov 1, 2018
Vaginal rejuvenation includes a range of procedures designed to reduce the internal and external ... more Vaginal rejuvenation includes a range of procedures designed to reduce the internal and external diameters of the vagina, mainly to improve sexual function and/or the appearance of the vagina. Women with symptoms of vaginal laxity because of childbirth or aging, seek these procedures. Conventional treatments include topical oestrogens, Kegel's exercises and corrective surgery to restore the pelvic floor. Newer minimally invasive treatments like carbon dioxide (CO 2 ) or erbium-doped yttrium aluminium garnet (EreYAG) laser and radiofrequency ablation of the vagina are becoming widely available and increasingly popular. Although these treatments have limited scientific evidence, they seem to be effective in improving vaginal laxity and providing symptom relief.
International journal of gynaecology and obstetrics, Nov 1, 2016
To assess the safety and efficacy of a modified technique of bilateral abdominal sacrocolpopexy i... more To assess the safety and efficacy of a modified technique of bilateral abdominal sacrocolpopexy in 18 which both uterosacral ligaments are replaced with polyvinylidene fluoride mesh to provide support to the cervix 19 (cervico-sacropexy [CESA]) or vaginal vault (vagino-sacropexy [VASA]). Methods: A retrospective observational 20 study was undertaken of women with posthysterectomy vault prolapse or recurrent apical prolapse following 21 previous vaginal repair who underwent bilateral sacrocolpopexy between July 1, 2013, and December 31, 2014, 22 in a tertiary referral unit in the UK. Before surgery and 3 months afterwards, prolapse was assessed using the Pelvic 23 Organ Prolapse Quantification scale and functional outcomes were recorded using the International Consultation 24 on Incontinence Questionnaire for vaginal symptoms and urinary incontinence. Results: Fifty women were included. 25 At 3 months, 47 (94%) patients reported no bulge symptoms and the mean point C was -7.6. Complications 26 comprised bladder injury in 1 (2%) and minor wound problems in 3 (6%) patients. No mesh erosion was reported. 27 Conclusion: Bilateral abdominal sacrocolpopexy seems to be a safe and effective option for apical prolapse. Longer-28 term follow-up is needed to detect prolapse recurrence and mesh-related complications.
John Wiley & Sons, Ltd eBooks, Feb 12, 2016
British Menopause Society Journal, May 6, 2015
Pelvic organ prolapse is a common gynaecological problem. Surgical techniques to repair prolapse ... more Pelvic organ prolapse is a common gynaecological problem. Surgical techniques to repair prolapse have been constantly evolving to reduce the recurrence of prolapse and need for reoperation. Grafts made of synthetic and biological materials became popular in the last decade as they were intended to provide extra support to native tissue repairs. However, serious complications related to use of synthetic meshes have been reported and there is increasing medico-legal concern about mesh use in prolapse surgery. Some mesh products already have been withdrawn from the market and the FDA has introduced stricter surveillance of new and existing products. Large randomized studies comparing mesh with non-mesh procedures are lacking which creates uncertainty for the surgeon and their patients. The small cohorts of the RCTs available with short follow-up periods just allow the conclusion that the mesh repair can be helpful in the short to medium term but unfortunately are not able to prove safety for all patients. In particular, current clinical reports cannot define for which indication what material may be superior compared to non-mesh repair. Quality control through long-term individual and national mesh registries is needed to keep a record of all surgeons using mesh and all devices being used, monitoring their effectiveness and safety data. Meshes with better biocompatibility designed specifically for use in vaginal surgery may provide superior clinical results, where the reduction of complications may allow a wider range of indications.
Manual of Urodynamics for Gynaecologists
European Journal of Obstetrics & Gynecology and Reproductive Biology, 2021
European journal of obstetrics, gynecology, and reproductive biology, 2021
OBJECTIVE Short-term postoperative voiding dysfunction (POVD) is common in women undergoing surge... more OBJECTIVE Short-term postoperative voiding dysfunction (POVD) is common in women undergoing surgery for pelvic organ prolapse. It results in increased catheter burden for patients and health services, and catheter-associated urinary tract infections (CAUTIs), thereby escalating the overall cost of treatment. Our aim was to determine the risk factors for voiding dysfunction following surgery for POP in our unit. STUDY DESIGN A retrospective case-control study conducted in a tertiary center in the U.K. The study cohort included all women who underwent surgery for pelvic organ prolapse between March 2017 and March 2019 and had a failed trial without catheter (TWOC). The control group comprised consecutive women on the surgical database who passed TWOC. Relevant data, including demographic details, past medical history, intraoperative and postoperative factors, were collected. We used the Chi-square test to calculate the statistical significance and multiple logistic regression analysis...
Obstetrics, Gynaecology & Reproductive Medicine, 2018
The Internet Journal of Gynecology and Obstetrics, 2009
Objective : To evaluate the efficacy of amoxicillin-clavulanic acid when given as a two dose vers... more Objective : To evaluate the efficacy of amoxicillin-clavulanic acid when given as a two dose versus the more traditional triple dose regimen for cesarean section prophylaxis. Methods : We conducted a prospective study of 122 women undergoing emergency cesarean section. All patients received 2.4 g of amoxicillin-clavulanic acid at the time of cord clamping intravenously. Subsequent doses of 1.2 g were administered 6 hours apart after the initial dose. Results : Patient characteristics and risk factors for infection were comparable for the two groups. Analysis of results demonstrated no significant differences in infective morbidity (6.5% versus 8.1%) between the two and triple dose groups respectively. Conclusion : The results of the present study suggest that two doses of amoxicillin-clavulanic acid is equally effective as triple dose therapy in reducing post cesarean section endometritis. This implies that two dose regimen would decrease the cost to the patient while maintaining very acceptable infection rates.
International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics, 2016
To assess the safety and efficacy of a modified technique of bilateral abdominal sacrocolpopexy i... more To assess the safety and efficacy of a modified technique of bilateral abdominal sacrocolpopexy in which both uterosacral ligaments are replaced with polyvinylidene fluoride mesh to provide support to the cervix (cervico-sacropexy [CESA]) or vaginal vault (vagino-sacropexy [VASA]). A retrospective observational study was undertaken of women with posthysterectomy vault prolapse or recurrent apical prolapse following previous prolapse repair who underwent bilateral sacrocolpopexy between July 1, 2013, and December 31, 2014, in a tertiary referral unit in the UK. Before surgery and 3 months afterwards, prolapse was assessed using the Pelvic Organ Prolapse Quantification scale and functional outcomes were recorded using the International Consultation on Incontinence Questionnaire for vaginal symptoms and urinary incontinence. Fifty women were included. At 3 months, 47 (94%) patients reported no bulge symptoms and the mean point C was -7.6. Complications comprised bladder injury in 1 (2%...
Post Reproductive Health, 2015
Pelvic organ prolapse is a common gynaecological problem. Surgical techniques to repair prolapse ... more Pelvic organ prolapse is a common gynaecological problem. Surgical techniques to repair prolapse have been constantly evolving to reduce the recurrence of prolapse and need for reoperation. Grafts made of synthetic and biological materials became popular in the last decade as they were intended to provide extra support to native tissue repairs. However, serious complications related to use of synthetic meshes have been reported and there is increasing medico-legal concern about mesh use in prolapse surgery. Some mesh products already have been withdrawn from the market and the FDA has introduced stricter surveillance of new and existing products. Large randomized studies comparing mesh with non-mesh procedures are lacking which creates uncertainty for the surgeon and their patients. The small cohorts of the RCTs available with short follow-up periods just allow the conclusion that the mesh repair can be helpful in the short to medium term but unfortunately are not able to prove safe...
Asian Journal of …, 2007
Eccrine Acrospiroma is a tumor of eccrine sweat glands with glycogen rich cells. Its treatment in... more Eccrine Acrospiroma is a tumor of eccrine sweat glands with glycogen rich cells. Its treatment involves wide excision with histological confirmation of clearance. Tumors that appear benign but show atypia on histology are associated with an increased risk of recurrence and also have malignant potential. They require wide excision and careful follow up. A case report.
The Obstetrician & Gynaecologist, 2010
International Urogynecology Journal, 2014
Gynecologic and Obstetric Surgery, 2016
Obstetrics, Gynaecology & Reproductive Medicine, Nov 1, 2018
Vaginal rejuvenation includes a range of procedures designed to reduce the internal and external ... more Vaginal rejuvenation includes a range of procedures designed to reduce the internal and external diameters of the vagina, mainly to improve sexual function and/or the appearance of the vagina. Women with symptoms of vaginal laxity because of childbirth or aging, seek these procedures. Conventional treatments include topical oestrogens, Kegel's exercises and corrective surgery to restore the pelvic floor. Newer minimally invasive treatments like carbon dioxide (CO 2 ) or erbium-doped yttrium aluminium garnet (EreYAG) laser and radiofrequency ablation of the vagina are becoming widely available and increasingly popular. Although these treatments have limited scientific evidence, they seem to be effective in improving vaginal laxity and providing symptom relief.
International journal of gynaecology and obstetrics, Nov 1, 2016
To assess the safety and efficacy of a modified technique of bilateral abdominal sacrocolpopexy i... more To assess the safety and efficacy of a modified technique of bilateral abdominal sacrocolpopexy in 18 which both uterosacral ligaments are replaced with polyvinylidene fluoride mesh to provide support to the cervix 19 (cervico-sacropexy [CESA]) or vaginal vault (vagino-sacropexy [VASA]). Methods: A retrospective observational 20 study was undertaken of women with posthysterectomy vault prolapse or recurrent apical prolapse following 21 previous vaginal repair who underwent bilateral sacrocolpopexy between July 1, 2013, and December 31, 2014, 22 in a tertiary referral unit in the UK. Before surgery and 3 months afterwards, prolapse was assessed using the Pelvic 23 Organ Prolapse Quantification scale and functional outcomes were recorded using the International Consultation 24 on Incontinence Questionnaire for vaginal symptoms and urinary incontinence. Results: Fifty women were included. 25 At 3 months, 47 (94%) patients reported no bulge symptoms and the mean point C was -7.6. Complications 26 comprised bladder injury in 1 (2%) and minor wound problems in 3 (6%) patients. No mesh erosion was reported. 27 Conclusion: Bilateral abdominal sacrocolpopexy seems to be a safe and effective option for apical prolapse. Longer-28 term follow-up is needed to detect prolapse recurrence and mesh-related complications.
John Wiley & Sons, Ltd eBooks, Feb 12, 2016
British Menopause Society Journal, May 6, 2015
Pelvic organ prolapse is a common gynaecological problem. Surgical techniques to repair prolapse ... more Pelvic organ prolapse is a common gynaecological problem. Surgical techniques to repair prolapse have been constantly evolving to reduce the recurrence of prolapse and need for reoperation. Grafts made of synthetic and biological materials became popular in the last decade as they were intended to provide extra support to native tissue repairs. However, serious complications related to use of synthetic meshes have been reported and there is increasing medico-legal concern about mesh use in prolapse surgery. Some mesh products already have been withdrawn from the market and the FDA has introduced stricter surveillance of new and existing products. Large randomized studies comparing mesh with non-mesh procedures are lacking which creates uncertainty for the surgeon and their patients. The small cohorts of the RCTs available with short follow-up periods just allow the conclusion that the mesh repair can be helpful in the short to medium term but unfortunately are not able to prove safety for all patients. In particular, current clinical reports cannot define for which indication what material may be superior compared to non-mesh repair. Quality control through long-term individual and national mesh registries is needed to keep a record of all surgeons using mesh and all devices being used, monitoring their effectiveness and safety data. Meshes with better biocompatibility designed specifically for use in vaginal surgery may provide superior clinical results, where the reduction of complications may allow a wider range of indications.
Manual of Urodynamics for Gynaecologists
European Journal of Obstetrics & Gynecology and Reproductive Biology, 2021
European journal of obstetrics, gynecology, and reproductive biology, 2021
OBJECTIVE Short-term postoperative voiding dysfunction (POVD) is common in women undergoing surge... more OBJECTIVE Short-term postoperative voiding dysfunction (POVD) is common in women undergoing surgery for pelvic organ prolapse. It results in increased catheter burden for patients and health services, and catheter-associated urinary tract infections (CAUTIs), thereby escalating the overall cost of treatment. Our aim was to determine the risk factors for voiding dysfunction following surgery for POP in our unit. STUDY DESIGN A retrospective case-control study conducted in a tertiary center in the U.K. The study cohort included all women who underwent surgery for pelvic organ prolapse between March 2017 and March 2019 and had a failed trial without catheter (TWOC). The control group comprised consecutive women on the surgical database who passed TWOC. Relevant data, including demographic details, past medical history, intraoperative and postoperative factors, were collected. We used the Chi-square test to calculate the statistical significance and multiple logistic regression analysis...
Obstetrics, Gynaecology & Reproductive Medicine, 2018
The Internet Journal of Gynecology and Obstetrics, 2009
Objective : To evaluate the efficacy of amoxicillin-clavulanic acid when given as a two dose vers... more Objective : To evaluate the efficacy of amoxicillin-clavulanic acid when given as a two dose versus the more traditional triple dose regimen for cesarean section prophylaxis. Methods : We conducted a prospective study of 122 women undergoing emergency cesarean section. All patients received 2.4 g of amoxicillin-clavulanic acid at the time of cord clamping intravenously. Subsequent doses of 1.2 g were administered 6 hours apart after the initial dose. Results : Patient characteristics and risk factors for infection were comparable for the two groups. Analysis of results demonstrated no significant differences in infective morbidity (6.5% versus 8.1%) between the two and triple dose groups respectively. Conclusion : The results of the present study suggest that two doses of amoxicillin-clavulanic acid is equally effective as triple dose therapy in reducing post cesarean section endometritis. This implies that two dose regimen would decrease the cost to the patient while maintaining very acceptable infection rates.
International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics, 2016
To assess the safety and efficacy of a modified technique of bilateral abdominal sacrocolpopexy i... more To assess the safety and efficacy of a modified technique of bilateral abdominal sacrocolpopexy in which both uterosacral ligaments are replaced with polyvinylidene fluoride mesh to provide support to the cervix (cervico-sacropexy [CESA]) or vaginal vault (vagino-sacropexy [VASA]). A retrospective observational study was undertaken of women with posthysterectomy vault prolapse or recurrent apical prolapse following previous prolapse repair who underwent bilateral sacrocolpopexy between July 1, 2013, and December 31, 2014, in a tertiary referral unit in the UK. Before surgery and 3 months afterwards, prolapse was assessed using the Pelvic Organ Prolapse Quantification scale and functional outcomes were recorded using the International Consultation on Incontinence Questionnaire for vaginal symptoms and urinary incontinence. Fifty women were included. At 3 months, 47 (94%) patients reported no bulge symptoms and the mean point C was -7.6. Complications comprised bladder injury in 1 (2%...
Post Reproductive Health, 2015
Pelvic organ prolapse is a common gynaecological problem. Surgical techniques to repair prolapse ... more Pelvic organ prolapse is a common gynaecological problem. Surgical techniques to repair prolapse have been constantly evolving to reduce the recurrence of prolapse and need for reoperation. Grafts made of synthetic and biological materials became popular in the last decade as they were intended to provide extra support to native tissue repairs. However, serious complications related to use of synthetic meshes have been reported and there is increasing medico-legal concern about mesh use in prolapse surgery. Some mesh products already have been withdrawn from the market and the FDA has introduced stricter surveillance of new and existing products. Large randomized studies comparing mesh with non-mesh procedures are lacking which creates uncertainty for the surgeon and their patients. The small cohorts of the RCTs available with short follow-up periods just allow the conclusion that the mesh repair can be helpful in the short to medium term but unfortunately are not able to prove safe...
Asian Journal of …, 2007
Eccrine Acrospiroma is a tumor of eccrine sweat glands with glycogen rich cells. Its treatment in... more Eccrine Acrospiroma is a tumor of eccrine sweat glands with glycogen rich cells. Its treatment involves wide excision with histological confirmation of clearance. Tumors that appear benign but show atypia on histology are associated with an increased risk of recurrence and also have malignant potential. They require wide excision and careful follow up. A case report.
The Obstetrician & Gynaecologist, 2010
International Urogynecology Journal, 2014
Gynecologic and Obstetric Surgery, 2016