Genital Disorders Research Articles

Genitourinary disease risks among ovarian cancer survivors in a population-based cohort study

ObjectiveWhile genitourinary complications during treatment for ovarian cancer are well-known, long-term adverse outcomes have not been well characterized. The number of ovarian cancer survivors has been increasing. The aim of this study was to investigate long-term adverse genitourinary outcomes in a population-based cohort. MethodsWe identified a cohort of 1270 ovarian cancer survivors diagnosed between 1996 and 2012 from the Utah Cancer Registry, and 5286 cancer-free women were matched on birth year and state from the Utah Population Database. Genitourinary disease diagnoses were identified through ICD-9 codes from electronic medical records and statewide healthcare facilities data. Cox proportional hazards models were used to estimate hazard ratios (HR) for genitourinary outcomes at 1 to <5 years and 5+ years after ovarian cancer diagnosis. ResultsOvarian cancer survivors had increased risks for urinary system disorders (HR: 2.53, 95% CI: 2.12–3.01) and genital organ disorders (HR: 1.88, 95% CI: 1.57–2.27) between 1 and <5 years after cancer diagnosis compared to the general population cohort. Increased risks were observed for acute renal failure, chronic kidney disease, calculus of kidney, hydronephrosis, pelvic peritoneal adhesions, and pelvic organ inflammatory conditions. Increased risks of several of these diseases were observed 5+ years after cancer diagnosis. ConclusionsOvarian cancer survivors experience increased risks of various genitourinary diseases compared to women in the general population in the long-term. Understanding the multimorbidity trajectory among ovarian cancer survivors is important to improve clinical care after cancer treatment is completed.

Ovary and ovarian bursa in dromedary camels: Clinical relevance of the topographical features

This study aimed to associate ovarian characteristics with the efficiency of clinical examination and occurrence of genital diseases in dromedary camels. The reproductive tract of 870 female camels was examined through standard transrectal palpation and by ultrasonography during the breeding season. The ovaries were examined for structures and dimensions. The follicles were categorized according to size, the thickness of the wall and contents. Follicle aspiration was carried out from females with overgrown follicles (OVGF, n=127), and the obtained follicular fluids were examined. At the slaughterhouse, 100 genital tracts were examined in situ and after dissection. Ovarian bursae were examined for patency and the presence of fluid (ovarian hydrobursitis, OVHB). Risks associated with the development of OVGF and OVHB were identified by the logistic regression. The results showed that, due to topographical difference, the right ovary was more accessible at rectal palpation than the left ovary (98.9% vs. 96.1%, p=.0005). Time needed for rectal palpation of the right ovary was shorter than the left ovary (25.1±25s vs. 34.6±34.5s, p=.03). Significant relationships were found between OVGF and OVHB (Odds ratio=10.5, p=.001), OVGF and clinical endometritis (Odds ratio=21.1, p=.001), OVGF and vaginal adhesion (Odds ratio=4.4, p=.03), and OVHB and clinical endometritis (Odds ratio=11.3, p=.001). Ultrasonographic examination was imperative for the differentiation between active corpus luteum, old non-active corpus luteum and small luteinized follicle. In conclusion, anatomical arrangement of the ovary and ovarian bursa in dromedary camels affects the likelihood of their accessibility during clinical examination and predisposes to unusual genital disorders.

Genital Infection and Associated Pathology in Red Sokoto and West African Dwarf Does in Makurdi

An abattoir survey of 84 genitalia of Sokoto (RS) and West African Dwarf (WAD) does was undertaken to investigate and compare bacterial isolates and associated genital disorders and conduct antimicrobial susceptibility of the isolates. Bacteriological examination showed that seven bacterial genera were identified from genital organs of RS and WAD does, respectively: Escherichia coli (64%, 63.2%), Pseudomonas spp (43.2%, 24.1%), Klebsiella spp (11.4%, 13.2%), Proteus spp (5.0%, 1.0%), Staphylococcus spp (5.0%, 8.0%) and Citrobacter spp (1.0%, 5.3%) and Enterobacter spp (in RS only) (2.0%). Escherichia coli and Pseudomonas spp were the dominant isolates. The rate of genital infection of RS and WAD does examined was highest with Escherichia coli (63.4%) and the pattern of bacterial isolation was high with Escherichia coli. There was no significant difference (P > 0.05) in the bacteria species colonizing the genital tracts of RS and WAD does. The relative risk (RR) for an infection of the uterus with Escherichia coli (1.08, 95% Confidence Interval (CI): 0.6588 to 1.769, P > 0.7606) was not significantly different in RS compared to WAD does. Bacteria were isolated from cases of endometritis, pyometra, postparturient metritis, mucometra, uterine congestion, melanosis, caruncular atrophy, salphingitis and cervicitis. Sensitivity test showed bacterial isolates were highly susceptible to Levofloxacin, Pefloxacin, Ciprofloxacin, Ofloxacin and Amoxyl. It was concluded that there was no difference in bacterial isolates in genital tracts of RS and WAD does and genital disorders could be associated with bacterial infections in does. The potentials of these bacterial isolates for producing genital pathology in does are likely to be high in Makurdi, north-central Nigeria. Therefore, management of genital disorders associated with these pathogens can be achieved with proper use of these antimicrobial agents in does.

Intrauterine Saline Infusion under Pressure for Opening Simple Buffaloes Oviductal Occlusions

Genital organ disorders are important causes of infertility and sterility in buffalo cows causing high economic losses. The oviducts are important for fertilization and the maintenance of the embryo until its arrival in to the uterus. Affections of the oviducts result in occlusion of the lumen preventing fertilization. The aim of this study was to open occluded oviducts of buffaloes' genital tracts by using intrauterine saline infusion under pressure. Ninety nine buffalo's genital tracts were collected from abattoir; saline solution was infused to one uterine horn with the aid of Foley catheter and under manual pressure on the filled uterine horn for 10 seconds. 175 oviducts were considered occluded. The type and duration of pressure which were applied on the filled uterine horn with occluded oviducts were divided to 4 groups. In the first group continuous pressure was applied for one minute, in the second group continuous pressure was applied for two minute, the third group intermittent pressure was applied for one minute and the fourth group intermittent pressure was applied for two minutes. The best result was the third group as (opening occluded oviducts was 88.2%, oviducts which not opened was 11.8%, 0% rupture of the uterine horn). In conclusion, oviductal saline infusion under intermittent pressure (OSIIP) succeeded in opening occluded oviducts of buffaloes genitalia collected from abattoir.

195 Retrospective Chart Review of Treatment Outcome Following Low-Intensity Shockwave Therapy for the Treatment of Vestibulodynia with Urogold 100™

Genital pain disorders have devastating effects on a woman’s quality of life, including social isolation. These disorders occur with high prevalence; more than 1/3 of women report pain during sexual activity, placing a significant financial burden on women and the healthcare system. Multiple medical treatments for dyspareunia are available to improve quality of life and decrease pain, however many are invasive, involving pharmacotherapy/hormone therapy/needle insertion/surgery, and are associated with significant morbidity. Low intensity shockwave therapy (LiSWT) is a non-invasive, non-pharmacologic, non-hormonal, non-surgical, low morbidity treatment strategy. FDA-cleared for pain amelioration in the US as non-significant risk in humans, Urogold 100™ is an electrohydraulic shockwave device that generates energy levels such as 0.10-0.12 mJ/mm2 with a unique parabolic reflector. This chart review represents the first US-based treatment outcome study in women with vestibulodynia using Urogold 100™. Patients presenting with vestibulodynia were offered the opportunity to receive LiSWT as a potential treatment for their genital pain disorder. As standard of care in our practice, patients completed the Female Sexual Function Index (FSFI), Sexual Distress Scale (SDS), vulvoscopy with photography, and cotton-tipped swab (Q-tip®) test at baseline. Vulvoscopic vulvar/vestibular photographs were scored for Vulvar/Vestibular Tissue Appearance (Vul/VestTA) (0 = normal appearance, 1 = minimal, 2 = moderate, 3 = severe concerns) for the vulva, vestibule and urethral meatus, with low scores associated with healthier tissue appearance. Cotton-tipped swab testing rated pain at the 1:00, 3:00, 5:00, 6:00, 7:00, 9:00 and 11:00 positions (0 = no pain, 1 = minimal, 2 = moderate, 3 = severe). The LiSWT protocol involved 6 treatment sessions, 3000 shocks each (1000 right/left lateral vestibule, and 1000 posterior vestibule), frequency 4/sec, membrane level 1. The energy varied from 0.10 – 0.12 mJ/mm2, based on patient toleration. Patients underwent vulvoscopy with photography and cotton-tipped swab testing prior to each LiSWT, as is routine in our practice. At the end of treatment, patients recorded their treatment response by Patient Global Impression of Improvement (PGI-I), a scale of 1 – 7 with clinically relevant improvement expressed by scores of 1 – 3.

Arterial supply to the rabbit male genital organs.

The improvement of veterinary care has prolonged the lifespan of rabbits, and the number of rabbits suffering from age-related, male genital disorders may increase in the near future. This could result in increased opportunities for male genital surgery, requiring knowledge of their arterial anatomy, which, however, has not been sufficiently studied. Therefore, the arteries supplying the genitals were observed in 20 male New Zealand White rabbits. The testis was supplied by the testicular artery originating from the abdominal aorta. The right testicular artery usually emerged at a more cranial level than the left artery (65%). The testicular artery encircled the testis in the sagittal plane and bifurcated (95%) or trifurcated (5%) at the caudal extremity of the testis before entering the parenchyma. The epididymis was supplied by the epididymal branches, either from only the testicular artery (75% of the right and 80% of the left halves) or from both the testicular artery and aorta. The deferent duct was supplied in all halves by the dorsal and ventral branches of the deferential artery, which usually arose from the umbilical artery. The accessory genital glands were supplied by the dorsal branch of the deferential artery and the prostatic artery. The latter, which emerged from the internal iliac artery, exhibited 3 branching types. The most frequent type (55% of the right and 45% of the left halves) had 3 branches supplying the accessory genital glands. These findings will help improve rabbit genital surgery.

Characteristics of HSV-2, M. genitalium and C. trachomatis in HPV Genotypes Associated with Cervical Intraepithelial Neoplasia and Genital Infections.

Cervical cancer is the most common cancer in women. High-Risk HPV types are known as the main agents involved in genital and cervical malignancies. There may be co pathogens like STIs that are involved in enhancing the susceptibility and progression to cervical neoplasia. This study was conducted to detect C. trachomatis, HSV-2 and M. genitalium using qPCR in women suffering from cervical intraepithelial neoplasia, HPV infection and non cancerous- non HPV subjects for the association of burden of genital disorders. This descriptive study was performed on 195 Liquid Based Cytology (LBCs) specimens collected from women referred to private laboratories. Fifty, 98 and 47 samples were from women with known CIN, HPV positive and non-cancerous/non-HPV, respectively. HSV-2, C. trachomatis, M. genitalium and HPV genotypes have been detected using multiplex TaqMan Real Time PCR and PCR hybridization. A total of 148 HPV positive samples were included. HPVs 6 (35.13%), 16 (32.43%), 18 (21.62%), 11 (9.46%), 31 (9.46%), and 51 (9.46%) were the most common genotypes. Single, 2, 3, and more than 4 multiple HPV genotypes were detected in 46%, 29.7%, 14.2%, 10.1% cases, respectively. The prevalence of M. genitalium, C. trachomatis and HSV2 was 3 (1.54%), 24 (12.3%) and 1(0.5%), respectively. There were no statistically significant differences between these pathogens and cervical intraepithelial neoplasia (p≥ 0.05). HR-HPV genotypes were more prevalent in genital infections and cervical cancer. It would seem early detection of dominant STI pathogens such as Chlamydia spp. gains due to effective prevention. Here, further research is needed to understand the co-infections burden of HPV genotypes with STIs in clinical manifestations.

Problem of urogenital mixed infections in reproductive aged women in current gynecology

A tendency of annual growth in inflammatory diseases of female genital organs is being observed now, and these diseases have a long-term recrudescent character with the inflammatory process chronization. Physicians of all specialties in a world medical practice prefer the term “pelvic inflammatory disease”. Goal of this literature review was to generalize the up-to-date data on the problem of the urogenital mixed infections in women of reproductive age. Reviewing both foreign and domestic literature sources published in recent 10 years on the problem of urogenital mixed infections in women of reproductive age. Рelvic inflammatory diseases is a group of diseases (independent nosological entities) of the upper region of female reproductive tract that combine endometritis, salpingitis, oophoritis, tubo-ovarian abscess and pelvis peritonitis. The highest it risks was noticed among the younger women of reproductive age (below 25) with unprotected sexual relationships and numerous sexual partners. Three different levels of genital organ disorders are distinguished dependent of the infection process localization: the lower level, the upper level and the mixed one, i.e. the combination of the lower and the upper levels. Vulvitis, vulvovaginitis, vaginitis and endocervicitis belong to the lower level of genital organ disorders, salpingo-oophoritis, endometritis, metroendometritis and pelvioperitonitis belong to the upper one, while the mixed level includes disorders of both upper and lower genital tracts. Considerable anatomic and functional changes in pelvic organs are formed in 1–2 years from the moment of the genital inflammatory disease beginning and traditionally are not detected at the initial stages of their progress, being, in most cases, accompanied by the reproductive and sexual health disorders. The mucous membranes of urinary tracts, vagina and uterine cervix are populated by various microorganisms that are in a constant antagonism or synergism with each other. Colonization resistance of the vagina and urinary tract mucous membranes provides the natural microbiocenosis stability, prevents pathogenic microorganism colonization and active reproduction of the conditionally pathogenic microflora.

A Noninvasive Aid for Office-Based Gynecologists for the Diagnosis of Common External Genital Disorders.

Background Gynecology and dermatology share the diagnosis and the management of some disorders of the female external genital area. In the last decade, clinical diagnosis in dermatology has dramatically improved, thanks to the introduction of dermatoscopy. Technique Dermatoscopy is a noninvasive, rapid, and simple technique performed with an affordable handheld instrument called dermatoscope, endowed with a light source and a high-quality lens achieving 10 times magnification. Experience The use of dermatoscopy for the diagnosis of some common external genital disorders, i.e., genital warts (GW), vestibular papillomatosis (VP), molluscum contagiosum (MC), angiokeratoma (AK), and pediculosis pubis (PP), is presented and discussed. Conclusion The use of dermatoscopy in a gynecologic office may considerably help the specialist to enhance in selected cases the clinical diagnosis and to avoid unnecessary and cumbersome investigations which may be time and money consuming.

Correlation of anti-Mullerian hormone with humanchorionic gonadotropin test in the evaluation of testicular function of children with 46 XY male hypogonadism: Use of anti-Mullerian hormone as abiomarker.

It is challenging to evaluate reproductive potential during childhood. These challenges necessitate the use of invasive dynamic tests. Although the anti-Mullerian hormone (AMH) is a reliable biomarker in evaluating testicular function, especially in the pre-pubertal period, there are uncertainties concerning its use in a clinical setting. This study is focused on comparing the AMH and human chorionic gonadotropin (hCG) test in boys with hypogonadism. A total of 160 boys aged between 0 and 18 years who presented with complaints associated with hypogonadism were prospectively enrolled in the study. All children were assigned to the following five groups: gonadal disorders (n = 34), androgen synthesis and end organ effect disorder (n = 48), isolated genital malformation disorders (n = 57), hypogonadotropic hypogonadism (n = 15) and constitutional delayed puberty (n = 6). All children underwent a short 3-day hCG test (1500 U/m2 /day). The concordance and correlation were evaluated between the hCG test and AMH. All groups exhibited a strong correlation (r160 = 0.689) and strong concordance (Kappa coefficient160 = 0.7) between the AMH and hCG test. Values of AMH higher than 32.7 pmol/L and hCG responses higher than 86 pmol/L were significant as indicative markers of functional testicular tissue presence. This study has shown that there is a strong correlation between the AMH and short-term hCG test and that values of AMH higher than 32.7 pmol/L and stimulated testosterone higher than 86 pmol/L can be used as indicators of functionally sufficient testicular tissue. These results indicate that AMH value can be used as a reliable and useful biomarker in the evaluation of the testicular function in 46 XY hypogonadism.

Комплексна реабілітаційна терапія генітального ендометріозу у жінок з ендометріоз-асоційованою безплідністю

The most relevant and least investigated questions are the relationships between genital endometriosis and disorders of the fertile function. It is precisely the lack of a clear algorithm for early detection of genital endometriosis and the choice of adequate treatment to further develop these issues, both for improving the quality of life in this category of women and for improving reproductive capacity. The objective: to increase the effectiveness of rehabilitation therapy in patients with genital endometriosis and defection of fertility based on evaluation of individual factors and immunological mechanisms of interaction and optimizing ways to overcome these negative influences. Materials and methods. To achieve this goal, 68 patients with endometriosis associated infertility were examined, which assessed the nature of the hormonal imbalance, violations of individual immune defense units in relation to the level fluctuations of individual tumor markers. In order to evaluate the effectiveness of the proposed program, a group of patients with endometriosis associated infertility was divided into two groups: the main group (38 women) and the comparison group (30 patients). The features of the proposed treatment program were the use after surgical manipulation of complex therapy with the use of progestogens (didrogesterone in contraceptive mode) and the antiproliferative complex: indole-3-carbinol and epigallocatechin-3-galate. Results. Characteristic features of adenomyosis are an increase in this category of patients with levels of LH (2.67 times) and FSH (1.98 times), mainly in the II phase of the menstrual cycle, as well as an increase in estradiol levels, especially in the follicular phase of the menstrual cycle (2, 13 times). In patients with internal endometriosis, in 30.9% of cases (according to ultrasound scan) and in 41.1% of cases (according to histological examination), there are manifestations of hyperplastic processes of endometrium. Increasing the serum CA-125 level (according to our data, 3.1-fold) in women with external genital endometriosis is an effective diagnostic marker to confirm the presence of this pathology. Conclusions. Thus, it should be noted that the proposed rehabilitation therapy for genital endometriosis in the postoperative period is effective in the treatment of pain syndrome and increasing fertility for endometriosis-associated infertility. Key words: genital endometriosis, infertility, hormonal imbalance, tumor markers, rehabilitation therapy.

Incidence of complications after laparoscopic and hysteroscopic surgeries for uterine myomas

Aim: to assess the incidence of complications after laparoscopic and hysteroscopic myomectomy.Materials and methods. The results of 378 laparoscopic and 292 hysteroscopic surgeries for uterine fibroids (myomas) have been retrospectively analyzed. All patients were examined for their history of gynecological and concomitant non-gynecological diseases, past surgeries, and the menstrual, sexual and reproductive functions. The patients underwent clinical blood analysis, urinalysis, electrocardiography and chest X-ray test, blood group and rhesus factor determination, hemostasis assay, blood analysis for RV, HIV and tumor markers, as well as transabdominal and transvaginal ultrasound using SSD-1200 and SSD-2000 devices (Aloka Ltd, Japan). We characterized the patients by the type of surgical intervention (laparoscopic or hysteroscopic), and also by age, indications for surgery, the number of fibroids and their locations, size of the uterus, presence of extragenital and genital disorders, and also by the surgery techniques. The post-surgery complication incidence rate was calculated and expressed as percentage (%), arithmetic mean (M), and standard error of the mean (m).Results. The overall incidence of severe postoperative complications did not differ between laparoscopic (2.7 ± 0.8 %) and hysteroscopic (2.1 ± 0.8 %) operations for uterine myomas (p &gt; 0.05). The incidence of complications was significantly higher in women operated by laparoscopy if they underwent simultaneous operations (12.3 ± 4.0 % vs. 0.6 ± 0.4 % for non-simultaneous operations), if the number of fibroids was &gt; 4 (3.9 ± 1.4 % vs. 1.1 ± 0.8 % in those with &lt; 4 fibroids), in the presence of anemia (8.2 ± 2.9 % vs. 1.0 ± 0.6 % in cases with no anemia), and in patients with menstruation disorders (4.9 ± 1.8 % vs. 1.3 ± 0.7 % with normal menstruation). The operated patients significantly differed by the number of uterine fibroids: the average number of fibroids was larger in those operated laparoscopically (2.9 ± 0.05 vs. 2.3 ± 0.04; p &lt; 0.01); the proportion of patients with 4 or more fibroids was also significantly higher in those patients (53.7 ± 2.6 % vs. 30.1 ± 2.7 %; p &lt; 0.001). The compared groups also differed in the location of their myomas.Conclusion. The risk of postoperative complications after laparoscopic surgery is relatively high if simultaneous operations take place, if the number of fibroids is ³ 4, and in the presence of anemia or menstruation disorder.

Ethnomedicinal Uses of Plant Resources in the Machhapuchchhre Rural Municipality of Kaski District, Nepal.

Background: Medicinal plants are being used by the majority of the population throughout the world for their primary health care needs. The reliance is also prevalent in Nepal, aided by its ethnic and biological diversity. This study aimed to catalogue the ethnomedicinal knowledge of plants used by local people of Machhapuchchhre Rural Municipality of Kaski district. Methods: Data were collected between February 2017 and April 2018 from eight different villages of the Kaski district by using semi-structured interviews, guided field works, focus group discussions, and in-depth interviews. The reported traditional uses were supported by local assistants, cataloguing vernacular names and crosschecking with the earlier published and gray literature. Results: A total of 105 medicinal plants, belonging to 58 families and 99 genera were documented to treat 70 different diseases and ailments. The highest numbers of plants (37) were used for gastrointestinal disorders and the lowest (4) were used for female genital disorders. Commonly used parts were underground portions (28 species) followed by fruits and seeds (25 species each). The most preferred dosage form was juice, used for 50 ailments, and the oral route was the most favored route of administration (77 species). The medicinal properties of 22 plant species were found hitherto unreported in the district. Conclusions: The study area was found to be rich in plant resources and the people have ample knowledge on the use of medicinal plants. Due to a lack of proper documentation, conservation, and cultivation practices, valuable plant species are at risk of extinction. Thus, appropriate conservation measures and scientific assessment of plant-lore in the district is immediately required.

Bovine Herpesvirus 1 Counteracts Immune Responses and Immune-Surveillance to Enhance Pathogenesis and Virus Transmission.

Infection of cattle by bovine herpesvirus 1 (BoHV-1) can culminate in upper respiratory tract disorders, conjunctivitis, or genital disorders. Infection also consistently leads to transient immune-suppression. BoHV-1 is the number one infectious agent in cattle that is associated with abortions in cattle. BoHV-1, as other α-herpesvirinae subfamily members, establishes latency in sensory neurons. Stressful stimuli, mimicked by the synthetic corticosteroid dexamethasone, consistently induce reactivation from latency in latently infected calves and rabbits. Increased corticosteroid levels due to stress have a two-pronged effect on reactivation from latency by: (1) directly stimulating viral gene expression and replication, and (2) impairing antiviral immune responses, thus enhancing virus spread and transmission. BoHV-1 encodes several proteins, bICP0, bICP27, gG, UL49.5, and VP8, which interfere with key antiviral innate immune responses in the absence of other viral genes. Furthermore, the ability of BoHV-1 to infect lymphocytes and induce apoptosis, in particular CD4+ T cells, has negative impacts on immune responses during acute infection. BoHV-1 induced immune-suppression can initiate the poly-microbial disorder known as bovine respiratory disease complex, which costs the US cattle industry more than one billion dollars annually. Furthermore, interfering with antiviral responses may promote viral spread to ovaries and the developing fetus, thus enhancing reproductive issues associated with BoHV-1 infection of cows or pregnant cows. The focus of this review is to describe the known mechanisms, direct and indirect, by which BoHV-1 interferes with antiviral immune responses during the course of infection.

FREQUENCY OF DETERMINATION OF PARENCHYMAL ORGANS DISTURBANCES DURING ULTRASOUND EXAMINATION OF REPRODUCTIVE TRACT

Ultrasound Real time 2D diagnostics, being an available and non-invasive method, issuccessfully used in human medicine, veterinary medicine and biology to diagnose bothphysiological and pathological conditions. In the case of small animals, the ultrasound is often usedto diagnose gravidity, number, size and vitality of fetuses as well as to diagnose pathologicalconditions present in the genital tract, and is also used to examine testicles and prostate of maleanimals. Today's advanced use of the ultrasound diagnostics provides us with an opportunity todetect numerous pathological conditions of reproductive tract of both female and male animals, andthose conditions directly affect health status of other internal organs. The aim of this study is todiagnose primary genital tract disorders using the ultrasound diagnostics, as well as proving itsconnection to the changes in parenchymal organs. The ultrasound examination was performed onthe total of 12 dogs, 6 male and 6 female dogs. Ovaries, uterus and the organs in the abdominal areawere examined using a transducer ranging from 5 to 8 MHz. A transducer of 7.5 MHz was used toexamine prostates and testicles. The patients were in dorsal position. Three out of six examined maledogs exhibited changes on their prostates, and the remaining one had a tumor on the testicles. Cystitisand hyperplasia of prostate were also found upon the examination of these dogs. One out of sixexamined female dogs, had cystic endometrial hyperplasia, three of them had pyometra, and one ofthem was diagnosed with an follicular cyst. In addition to these pathological conditions, changeswere noticed in the liver and pancreas. Along with the detection of primary changes in the genitaltract of both male and female animals, the ultrasound diagnostics can be used to discover consequentchanges in parenchymal organs.

Barriers to implementation of guidelines for the diagnosis and management of undescended testis.

Cryptorchidism or undescended testis (UDT) is one of the most common genital disorders identified at birth. The gold standard for treatment in the US is to surgically bring the UDT into the scrotal sac. In 2014, the American Urologic Association (AUA) presented a guideline for evaluation and treatment of cryptorchidism. We reviewed some of the most recent domestic and international studies examining the results of implementing the AUA and similar guidelines for the diagnosis and management of UDT. In addition, we reviewed some of the more common barriers to the implementation of the AUA guidelines and offered recommendations on how to increase the rate of early detection of UDT, thereby increasing the rate of surgical correction at the appropriate age.

Genital Tract Pathology in Female Pet Guinea Pigs (Cavia porcellus): a Retrospective Study of 655 Post-mortem and 64 Biopsy Cases

Disorders of the female genital tract are among the most common disorders in pet guinea pigs (Cavia porcellus); however, knowledge of many aspects of these disorders is sparse, especially regarding their incidence and age distribution. Ovarian cysts, as the most common genital tract disorder in guinea pigs, have been investigated in detail; however, information on the nature of these cysts is inconsistent. The present study reviewed genital tract disorders occurring within 655 full post-mortem examinations of intact female pet guinea pigs and 64 female genital tract biopsies examined over a 22.5 year period. Age distribution was determined from 550 post-mortem examinations of animals of known age. Genital tract disorders were found in 295 post-mortem examinations (45.0%) in animals with a median age of 52 months. Additionally, disorders were found in all genital tract biopsy samples from guinea pigs with a median age of 48 months. The incidence of genital tract diseases increased from 1.5% in guinea pigs ≤6 months of age to up to 77.8% in animals >6 years of age. Ovarian cysts were the most common genital tract disorder, found in 245 of the 655 post-mortem cases (37.4%) and 38 of 43 ovarian biopsy samples (88.4%). The incidence of ovarian cysts increased with advancing age, reaching 75.6% in animals >6 years. In 119 cases, histopathology and immunohistochemistry confirmed cystic rete ovarii as the only cyst type. A Fallopian tube adenoma was found in a single case, so disorders of the Fallopian tube should be considered rare. Uterine disorders were diagnosed in 17.4% of the post-mortem examinations and 98.1% of uterine biopsy samples. Uterine neoplasia, hyperplasia and inflammation were common, but occurred at different ages. The incidence of uterine neoplasia and hyperplasia was higher in older animals (>15% in guinea pigs >6 years), while the incidence of uterine inflammation was the highest (17.9%) in animals aged 7-12 months. An association between ovarian cysts and uterine neoplasia or hyperplasia was not evident. Vaginal disorders were rare and included leiomyoma, polyps and vaginitis.

Genital Tract Pathology in Female Pet Rabbits (Oryctolagus cuniculus): a Retrospective Study of 854 Necropsy Examinations and 152 Biopsy Samples

Genital tract disorders, especially uterine disorders, are the most common conditions of the female pet rabbit (Oryctolagus cuniculus); however, there have been few large studies of diseases of the female genital tract of this species. The present study examined diseases of the ovaries, Fallopian tubes, uterus and vagina, retrospectively over a period of 22 years, and included 854 full post-mortem examinations of female pet rabbits and 152 female genital tract biopsy samples. The age distribution of uterine neoplasia, endometrial hyperplasia and uterine inflammation was determined in the post-mortem cases. Uterine disorders were a common finding, occurring in 26.8% of all full necropsy examinations and in almost all genital tract biopsy samples. Uterine tumours (n=205) were the most common uterine pathology, with adenocarcinoma being the most frequent tumour type. Metastasis was found in 46.2% of rabbits with uterine adenocarcinomas diagnosed at post-mortem examination, with metastatic spread to the lung occurring in 79.1% of these animals. The second most common uterine pathology was endometrial hyperplasia, which was glandular-cystic in most cases. The incidence of uterine tumours and endometrial hyperplasia increased with age, while endometrial hyperplasia was found more commonly in slightly younger animals. In contrast, uterine inflammation, the third most common finding, was found predominately in young to middle-aged rabbits. Ovarian disorders were found rarely at post-mortem examinations (3.3% of all animals), but comprised 16.9% of biopsy samples. Of these, ovarian cysts, especially follicular cysts,and secondary tumours were found most frequently. Disorders of the Fallopian tube and the vagina were found in <1% of cases and should be considered rare.

640 Medico-legal evaluation of patients with genital disorders in Upper Egypt: a preliminary data

In Upper Egypt, the Forensic Medicine Authority of the Ministry of Justice transfers patients with genital disorders for proper Andrological evaluation, which helps in making its decisions according to the Law. Therefore, our study aims to evaluate the types of cases referred for andrological evaluation, their clinical, laboratory, imaging characteristics and finally the decisions of these cases. The study included 15 patients with genital disorders who referred from the forensic medicine authority for evaluation. Initial evaluation was done through history taking, general & genital examination. Hormonal profile including total Testosterone, FSH, LH, Prolactin, Estradiol (E2), and random blood sugar were done. Karyotyping, scrotal and/or penile color Doppler were done when appropriate. Data was presented as median (range), or percentage (%) when appropriate. Patients' characteristics showed age 29.5 (1-46) years. Most patients were married 73.3% (11/15). Cause of referral was mainly for erectile function evaluation due to marital conflicts 60%. (9/15). Other causes included sex determination 20% and genital assault 20%. All cases were free from medical co-morbidity (Diabetes, Hypertension) except one patient was with Dyslipidemia. General examination was normal in most patients 80% (12/15). Abnormal genital examination was noted in the form of hypospadias 13.3% (2/15), atrophic testis 26.6% (4/15), and varicocele 40% (6/15). Patients hormonal profile showed total testosterone 4.6 (3.69-7.82) ng/ml, FSH 3.53 (0.6-59.4) mIU/ml, LH 4.6(1.2-23.8) mIU/ml, prolactin 12.55 (4.9-18) ng/ml, and E2 43 (24-56.9) pg/ml. As regards the erectile function evaluation, patients with normal evaluation, venogenic, arteriogenic erectile dysfunction 26.7% (4/15), 26.7% (4/15), 6.6% (1/15) respectively. Other patients' diagnosis included normal genitalia, atrophic testis, and male pseudo hermaphrodite.

The Nomogram of Penile Length and Circumference in Iranian Term and Preterm Neonates.

The normal length of penis in preterm and term neonates is different among different nations, and is affected by various factors. The present study aimed to determine stretched penile length (SPL) values and cutoff level of micropenis in term and preterm Iranian neonates, for the first time. All male neonates born in two general hospitals of Tehran (Akbarabadi, and Rasoul hospitals), center of Iran, with gestational age of 28-42 weeks were included and their SPL and penile circumference (PC) were examined on the first 3 days after birth by the same physician. Birth weight (BW), and height, gestational age, type of delivery, mother's age, twin/multiple pregnancy, drug, and medical history of mother during pregnancy were recorded and cutoff levels of two variables were calculated based on the collected variables for different gestational ages. Among a total of 587 neonates, 203 neonates were born term and 384 preterm. Mean ± SD of neonates' BW were 2,682.51 ± 739.30 (850-4800) gr. Mean ± SD of their SPL was 22.48 ± 3.34 mm; 25.92 ± 1.54 mm in term and 20.66 ± 2.50 mm in preterm infants (P = 0.001). Mean ± SD of PC was 6.71 ± 1.31 mm; 8.14 ± 0.48 in term and 5.96 ± 0.92 in preterm infants (P = 0.001). SPL and PC were significantly correlated with type of delivery, number of parity, gestational age, BW, and crown-heel length, head circumference (P < 0.001). This study suggested that SPL in male neonates was 22.48 mm and PC was 6.71 mm, both correlated with gestational age and BW. Due to the ethnical variety of this cutoff points and lack of an appropriate study in Iran, these cutoff points can be used by all physicians as a reference for Iranian newborns (term and preterm), in order to prevent misdiagnosis of micropenis and genital disorders.