Literature Review of Vaginal Stenosis and Dilator Use in Radiation Oncology

Damast, Shari; Jeffery, Diana D.; Son, Christina H.; Hasan, Yasmin; Carter, Jeanne; Lindau, Stacy Tessler; Jhingran, Anuja

doi:10.1016/j.prro.2019.07.001

Cited by 53 publications

(42 citation statements)

References 55 publications

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“…Disruptions to microbiome levels may contribute to bacterial vaginosis, contact dermatitis and Candida albicans growth 13 . This is an important consideration given the prolonged time frames that female pelvic patients’ may be advised to use lubricant and dilators 2,4‐10 …”

Section: Discussionmentioning

confidence: 99%

“…Female patients who receive RT for pelvic cancers may experience side effects such as adhesions, stenosis and shortening of the vagina due to fibrosis 1 . These physical changes can result in long‐term sexual dysfunction for women, as well as compromising follow‐up pelvic examinations 2,3 and potentially surveillance of disease recurrence 4 . Dilation is often indicated as an intervention for the management of adhesions and stenosis 5 .…”

Section: Introductionmentioning

confidence: 99%

“…Despite this, vaginal dilation remains an internationally accepted management strategy for radiation therapy‐induced vaginal adhesions and stenosis (RTVAS) with vaginal dilation reported as a standard intervention procedure in the United Kingdom (UK), Netherlands and Australia 1‐2,4,6‐9 . Patient education is a fundamental component of RTVAS side effect management.…”

Section: Introductionmentioning

confidence: 99%

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Management of radiation therapy‐induced vaginal adhesions and stenosis: A New Zealand survey of current practice

Summerfield

Leong

2020

J of Medical Radiation Sci

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Introduction: Vaginal dilation is often indicated as an intervention for the management of radiation therapy-induced vaginal adhesions and stenosis (RTVAS). However, limited research exists underpinning this intervention and diversity in patient recommendations internationally are reported. In the absence of New Zealand (NZ) national guidelines regarding the management of RTVAS, a survey of NZ radiation therapy departments was conducted to gain an overview of current practice. Methods: A two-section online survey was developed to capture RTVAS education and management overview across NZ. Section one focused on departmental resourcing and section two on local standard practice regarding vaginal dilator usage. One RTVAS education representative from each department was invited to complete the survey. Results: Eight of nine NZ departments completed the survey. Consistent treatment indications were identified for RTVAS patient education with the involvement of diverse staffing groups at various time-points throughout the treatment process. Protocols for RTVAS management existed in each RT department with staff commonly trained by informal peer observation. Dilator usage was recommended regardless of patient sexual activity. Agreement was shown regarding the recommended start time of dilator usage and frequency. The recommended duration of dilator use post-treatment varied from 6 months to greater than 36 months. Conclusions: This work illustrates both concordance and diversity in practice and contributes to the limited body of literature available. Further research is warranted to explore patterns of practice between departmental protocols and individual practitioners in further detail.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Management of radiation therapy‐induced vaginal adhesions and stenosis: A New Zealand survey of current practice

Summerfield

Leong

2020

J of Medical Radiation Sci

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“…A Tabela 2 apresenta a proporção de adesão para cada orientação, bem como sua classificação. A estenose vaginal é definida como encurtamento e/ou estreitamento do canal vaginal, de acordo com Common Terminology Criteria for Adverse Events (CTCAE v3.0) (15) e é classificada como um efeito agudo ou tardio pois pode ocorrer em semanas ou até 48 meses após o término da radioterapia (16)(17) . A estenose vaginal decorre de uma inflamação progressiva e constante que pode ser induzida pela radiação ionizante, desde a teleterapia como também por alterações hormonais, tais como o hipoestrogenismo (16) .…”

Section: Métodounclassified

“…A estenose vaginal é definida como encurtamento e/ou estreitamento do canal vaginal, de acordo com Common Terminology Criteria for Adverse Events (CTCAE v3.0) (15) e é classificada como um efeito agudo ou tardio pois pode ocorrer em semanas ou até 48 meses após o término da radioterapia (16)(17) . A estenose vaginal decorre de uma inflamação progressiva e constante que pode ser induzida pela radiação ionizante, desde a teleterapia como também por alterações hormonais, tais como o hipoestrogenismo (16) . Essas alterações são causadas, principalmente, pelo aumento da produção de colágeno no tecido conjuntivo fibroso, desenvolvendo estreitamento e encurtamento do canal vaginal e requerem prevenção para dirimir sua severidade pois sua ocorrência pode resultar em alterações vaginais permanentes (16) .…”

Section: Métodounclassified

Avaliação da adesão ao autocuidado em mulheres submetidas à braquiterapia ginecológica

Martelletti

Vasconcelos

Bontempo

et al. 2020

R. Enferm. Cent. O. Min.

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Objetivo: Avaliar a adesão das mulheres com câncer cervical às orientações de autocuidado relacionadas à braquiterapia. Método: Estudo longitudinal, realizado em um ambulatório de radioterapia na região centro-oeste, com mulheres com câncer cervical submetidas à braquiterapia. As participantes responderam ao questionário sobre adesão às orientações de autocuidado durante o tratamento. Resultados: Trinta mulheres com idade entre 22 e 76 anos participaram do estudo. Das 12 orientações, as pacientes reportaram adesão boa em seis(50%), moderada em quatro (33%), e baixa em duas (17%). Apenas sete (23%) das pacientes aderiram ao uso de dilatadores vaginais pós-braquiterapia para prevenção da estenose vaginal. Em média, as pacientes aderiram à nove das doze orientações recebidas. Conclusão: As pacientes apresentaram boa e moderada adesão para a maioria das orientações fornecidas. Sugere-se que intervenções educativas sejam implementadas para melhorar a comunicação visual e consequentemente melhorar a adesão às orientações de autocuidado em braquiterapia.

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A feasibility study of three‐dimensional ultrasound imaging of the vagina under distension

Zhang,

Blokker,

Borazjani

et al. 2023

Medical Physics

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BackgroundThe distension properties of the vagina are critical to its function including support of surrounding organs, childbirth, and intercourse. It could be altered by many pathophysiological processes like pregnancy, radiotherapy, and reconstruction surgery. However, there are no clinically available diagnostic tools capable of quantifying the distension properties of the vagina.PurposeA proof‐of‐concept study was designed to assess the feasibility of a novel three‐dimensional (3D) ultrasound imaging technique that allows quantitative evaluation of the vagina under distension.MethodsPatients with symptomatic pelvic organ prolapse (POP) were recruited for the study. An ultrathin, oversized bag was inserted into the vagina and filled with water using a modified urodynamics system. The instilled water volume and intravaginal pressure were continuously recorded. At maximum vaginal capacity, 3D transintroital ultrasound of the distended vagina and surrounding pelvic structures was performed. Exams were performed in duplicate for each patient, two hours apart (round A and round B). Following the development of a 3D surface model of the distended vagina from each scan, several measurements were obtained, including cross‐sectional area, anteroposterior (AP) length and lateral width in the plane of minimum hiatal dimensions (PMHD), AP and lateral diameter at the pubic symphysis (PS) level, maximum and minimum diameter, and maximum vertical length. To assess repeatability between measurements in two rounds, the coefficient of variation (CV) and the intraclass correlation coefficient (ICC) were calculated for each measurement. Correlations between physical measurements including the pelvic organ prolapse quantification (POP‐Q) system and vaginal diameter measurements, and obtained metrics were also assessed.ResultsSixteen patients with POP (average age 69 years) completed both rounds of imaging. There was sufficient echogenicity on 3D transintroital ultrasound of the distended vaginal wall to establish boundaries for 3D surface models of the vagina. Overall, all metrics had good or excellent reliability (ICC = 0.77–0.93, p < 0.05; CV = 3%–18%) except maximum diameter, which demonstrated only moderate reliability (ICC = 0.67, p = 0.092). Strong correlations were found between physical exam measurements including D point of POP‐Q, introitus diameter and lateral diameter at apex, and maximum vaginal capacity, maximum vertical length, lateral diameter at PS, minimum diameter, and distended PMHD measurements. The results demonstrated that this system could generate 3D models of the shape of the distended vagina and provide multiple metrics that could be reliably calculated from automated analyses of the models.ConclusionsA novel system for evaluation of the distension properties of the vagina was developed and preliminary evaluation was performed. This system may represent a technique for evaluation of the biomechanical and structural properties of the vagina.

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Literature Review of Vaginal Stenosis and Dilator Use in Radiation Oncology

Cited by 53 publications

References 55 publications

Management of radiation therapy‐induced vaginal adhesions and stenosis: A New Zealand survey of current practice

Management of radiation therapy‐induced vaginal adhesions and stenosis: A New Zealand survey of current practice

Avaliação da adesão ao autocuidado em mulheres submetidas à braquiterapia ginecológica

A feasibility study of three‐dimensional ultrasound imaging of the vagina under distension

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