***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The objective of the study was to assess the effects of low-dose vaginal treatment with oestradiol before vaginal operation . In a double-blind r and omized study including 43 postmenopausal women scheduled for vaginal repair operation for genital descensus , it was found that 7 patients suffered from concomitant urinary stress incontinence .  Vagifem ( 25 micrograms oestradiol ) or placebo was administered as vaginal pessaries daily , 3 weeks prior to surgery and the clinical effects evaluated . One month postoperatively the prevalence of bacteriuria ( > 100,000 CFU/ml urine ) was significantly lower when using oestradiol than in the placebo group . At follow-up 3 years later 40 women ( 93 % ) answered the question naires . None received hormone replacement therapy . Nineteen percent in the preoperative oestradiol group and 11 % in the preoperative placebo group had had more than two episodes of cystitis treated with antibiotics . This difference is not statistically significant ( p > 0.05 ) . Recurrent cystitis was not correlated to bacteriuria postoperatively . Seventy-nine percent of the women with genital prolapse but only 29 % of the women with concomitant urinary stress incontinence were cured ( p < 0.05 ) . Neither preoperative  oestradiol  treatment nor body weight had any influence on relapse . Preoperative low-dose vaginal oestradiol treatment may reduce the incidence of bacteriuria in the immediate postoperative period but no long-lasting effects on recurrent cystitis or relapse were seen . Longer-lasting hormone replacement therapy may be necessary to achieve lasting effects Summary We studied the effect of perioperative clindamycin ( 3 × 600 mg in 100 ml 0.9 % saline ) , metronidazole ( 3 × 500 mg in 100 ml 0.9 % saline ) and a placebo ( 3 × 100 ml of 0.9 % saline ) in 120 patients having a vaginal hysterectomy without colporrhaphy .  The rate of postoperative urinary tract infections was significantly higher in the placebo group , but there was no significant difference between the three groups in the days of postoperative fever ( a temperature above 37 ° C ) or in the length of hospital stay . One patient on placebo had a vault infection and another had a fever of unknown origin OBJECTIVE To compare the prophylactic efficacy of 1 g ceftriaxone with 1.5 g cefuroxime + 0.5 g metronidazole for  febrile morbidity and urinary tract infection in patients undergoing vaginal hysterectomy . STUDY DESIGN A prospect i ve , r and omized , comparative , non-blinded study with at least 100 patients on each side . The two- sample t-test was used for testing e quality of two means and the chi 2 test was used for pair differences . RESULTS Single dose cefuroxime + metronidazole and ceftriaxone were equally effective in preventing febrile morbidity postoperatively . Additionally ceftriaxone was more effective in sterilizing pre-operatively existing bacteriuria A r and omized double-blind prospect i ve study on the efficacy of single-dose antibiotic prophylaxis compared cefuroxime versus metronidazole versus the combination of both agents in vaginal hysterectomy . Overall antibiotic prophylaxis was effective in abscess prevention ( one abscess in 68 patients ) . In the metronidazole group a significantly higher grade of morbidity was observed : febrile morbidity 41 % versus 4 % in the two other groups ; bacteriuria 73 % versus 17 % in the cefuroxime group , versus 13 % in the combined group ; urinary tract infection 23 % , versus 0 % in the two other groups ; post-operative prescription of antibiotics 41 % , versus 0 % in the two other groups . Febrile morbidity and bacteriuria correlated positively withEscherichia coli and Proteus spp . These micro-organisms were recovered significantly more often from the vagina of patients in the metronidazole group . Cefuroxime was successful , metronidazole failed in the prevention of minor morbidity . We could not observe any effect from the addition of metronidazole to the cefuroxime prophylaxis Abstract Numerous studies have been published in recent years about antimicrobial prophylaxis in gynecologic surgery , but the optimal drug and schedule for the different surgical procedures is still a matter of debate . The aim of the present study was to compare two ultra-short term antimicrobial prophylaxis regimens ( amoxicillin-clavulanic acid and cefazolin ) in preventing infections following laparoscopic gynecologic operations . Three hundred sixty women hospitalized for a laparoscopic gynecologic surgery procedure were included in the study between January 1999 , and December 2001 . Patients were r and omly allocated to receive amoxicillin-clavulanic acid ( 2.2 g ) [ Group A ] or cefazolin ( 2 g ) [ Group B ] as a single dose 30 minutes before surgery . Each patient was assessed daily until discharge to evidence febrile status and the presence of infections at the operative site , urinary tract and respiratory tract . In the amoxicillin-clavulanic acid ( Group A ) and cefazolin ( Group B ) groups , overall 164 and 172 patients , respectively , were evaluable for prophylactic efficacy at hospital discharge . Infectious complications were infrequent in both groups with febrile morbidity occurring in only one patient ( 0.6 % ) in the amoxicillin- clavulanic group . No sign of infections at the surgical site , urinary tract and respiratory tract was observed in either group . No death due to sepsis was recorded . It is concluded that ultra-short term prophylaxis with both amoxicillin-clavulanic acid and cefazolin is safe and effective in elective laparoscopic gynecologic surgery A prospect i ve r and omized study was conducted comparing a single 2.2 g preoperative dose amoxycillin/clavulanic acid with a regimen of 1.5 g cefuroxim combined with 0.5 g metronidazole .  Two hundred and fifty-one women were evaluated in this comparative study . The febrile morbidity , the incidence of urinary tract infections and the hospital stay were similar in both regimens . A single preoperative dose of  amoxycillin/clavulanic acid was as effective as a combined regimen of cefuroxim and metronidazole and less expensive Abstract . Ninety‐two patients with preoperative sterile urine undergoing colposuspension or vaginal repair operation for stress urinary incontinence and /or genital descensus were r and omized to either suprapubic or transurethral postoperative catheter drainage .  The prevalence of significant bac‐teriuria on the fifth postoperative day was statistically significantly lower when using suprapubic catheter ( 20.8 % ) than with transurethral catheter drainage ( 45.5 % ) . This applied especially to colposuspension . The rate of postoperatively impaired bladder emptying also tended to be reduced when using suprapubic catheter . At follow‐up after one year , postoperative bacteriuria was closely correlated to increased rates of both clinical cystitis and asymptomatic significant bacteriuria . Thus it is recommended to use suprapubic bladder drainage not only after colposuspension but also after vaginal repair in an effort to avoid an increased risk of urinary infections A double-blind , placebo-controlled and r and omized trial involving a total of 295 patients was carried out to define the role of chemoprophylaxis in major gynaecological surgery in our hospital . Perioperative administration of a single dose of ampicillin ( 500 mg ) plus sulbactam ( 500 mg ) ( regimen A ) , or ampicillin ( 500 mg ) plus metronidazole ( 1 g suppository ) ( regimen B ) , gave similar results . After abdominal hysterectomy , the rates of post-operative wound infection and febrile morbidity were significantly reduced from 24 % ( 12/49 ) and 20 % ( 10/49 ) in the placebo group to 3 - 4 % ( A = 2/51 , B = 3/58 ) and 2 % ( A = 1/51 , B = 1/58 ) respectively . After vaginal hysterectomy , pelvic/vaginal infection or febrile morbidity was found in 30 % ( 3/10 ) of patients in the placebo group but none in either treatment group ( A = 10 , B = 8) . After other types of operation , the rates of infectious complications were reduced , but not statistically significantly , from 11 % ( 4/38 ) to 4 % ( A + B 2/71 ) . However , the rates of post-operative urinary tract infection remained similar in the placebo and treatment groups ( 12 - 16 % ) BACKGROUND Recurrent urinary tract infections are a problem for many postmenopausal women .  Estrogen replacement restores atrophic mucosa , lowers vaginal pH , and may prevent urinary tract infections . METHODS We enrolled 93 postmenopausal women with a history of recurrent urinary tract infections in a r and omized , double-blind , placebo-controlled trial of a topically applied intravaginal estriol cream . Midstream urine cultures were obtained at enrollment , monthly for eight months , and whenever urinary symptoms occurred . Vaginal cultures and pH measurements were obtained at entry and after one and eight months . The women were assigned to receive either estriol ( n = 50 ) or placebo ( n = 43 ) , both administered intravaginally ; 36 and 24 , respectively , completed the eight months of follow-up . RESULTS The incidence of urinary tract infection in the group given estriol was significantly reduced as compared with that in the group given placebo ( 0.5 vs. 5.9 episodes per patient-year , P < 0.001 ) . Survival analysis showed that more of the women in the estriol group than in the placebo group remained free of urinary tract infection ( P < 0.001 ) . Lactobacilli were absent in all vaginal cultures before treatment and reappeared after one month in 22 of 36 estriol-treated women ( 61 percent ) but in none of the 24 placebo recipients ( P < 0.001 ) . With estriol the mean vaginal pH declined from 5.5 to 3.8 ( P < 0.001 ) , whereas there was no significant change with placebo . The rate of vaginal colonization with Enterobacteriaceae fell from 67 percent to 31 percent in estriol recipients but was virtually unchanged ( from 67 to 63 percent ) in the placebo recipients ( P < 0.005 ) . Side effects were minor , but caused 10 estriol recipients ( 28 percent ) and 4 placebo recipients ( 17 percent ) to discontinue treatment . CONCLUSIONS The intravaginal administration of estriol prevents recurrent urinary tract infection in postmenopausal women , probably by modifying the vaginal flora OBJECTIVES Our purpose was to determine whether a vaginal or abdominal approach is more effective in correcting  uterovaginal prolapse .  STUDY DESIGN Eighty-eight women with cervical prolapse to or beyond the hymen or with vaginal vault inversion > 50 % of its length and anterior vaginal wall descent to or beyond the hymen were r and omized to a vaginal versus abdominal surgical approach .  Forty-eight women underwent a vaginal approach with bilateral sacrospinous vault suspension and paravaginal repair , and 40 women underwent an abdominal approach with colposacral suspension and paravaginal repair . Ancillary procedures were performed as indicated . Detailed pelvic examination was performed postoperatively by the nonsurgeon coauthor yearly up to 5 years . The women were examined while st and ing during maximum strain . Surgery was classified as optimally effective if the woman remained asymptomatic , the vaginal apex was supported above the levator plate , and no protrusion of any vaginal tissue beyond the hymen occurred . Surgical effectiveness was considered unsatisfactory if the woman was symptomatic , the apex descended > 50 % of its length , or the vaginal wall protruded beyond the hymen . RESULTS Eighty women ( vaginal 42 , abdominal 38 ) were available for evaluation at 1 to 5.5 years ( mean 2.5 years ) . The groups were similar in age , weight , parity , and estrogen status , and 56 % had undergone prior pelvic surgery . There was no significant difference between the groups in morbidity , complications , hemoglobin change , dyspareunia , pain , or hospital stay . The vaginal group had longer catheter use , more urinary tract infections , more incontinence , decreased operative time , and lower hospital charge . Surgical effectiveness was optimal in 29 % of the vaginal group and 58 % of the abdominal group and was unsatisfactory leading to reoperation in 33 % of the vaginal group and 16 % of the abdominal group . The reoperations included procedures for recurrent incontinence in 12 % of the vaginal and 2 
    Output:
    
The use of a cephalosporin as perioperative antimicrobial prophylaxis is the optimal regimen in preventing UTIs after pelvic floor surgery