History Of Previous Pelvic Surgery Research Articles

Outcome of Difficult Pelvis Surgeries done by Gynecologist versus General Surgeons

Objective: To evaluate the outcomes of difficult pelvis surgeries done by gynecologist versus general surgeons. Study Design: Retrospective study Place and Duration of Study: Department of Surgery, CMH Kharian Medical College, Kharian, Department of Surgery, Wah Medical College POF Hospital, Wah Cantt and Ghulam Muhammad Mahar Medical College, Teaching Hospital, Sukkur from 1st August 2015 to 31st July 2018. Methodology: Fifty professionals (who conducted 500 pelvic surgeries) were included either from the surgery or obstetrics gynecology departments. The study was initiated post-consent of each participant. Surgeons National Surgical Quality Improvement Program (NSQIP) data base software was applied for designing the questionnaire. The NSQIP database collects information from 10 perioperative-variables, as well as preoperative-comorbidities, parity, previous history of pelvic surgery, ureteral obstruction and vesico-vaginal fistula, intraoperative-variables, as well as 30-day mortality and morbidity outcomes including the rate of reoperation and re-admission. Other information regarding ASA classification and malignancy were also collected. Result: There were 341 procedures performed by surgeons while 159 procedures were conducted obstetrics gynecologists’ surgeons. The mean age of the patients was 62.5±11.5 years. The ASA classification presented higher number of surgeries in class 1 and 2 of the ASA class. The apical procedures as Sacrospinous and Sacrocolpopexy were performed highest by obstetrics gynecologists. The 30 days postoperative complication rate was increased significantly in the obstetrics gynecologists group than the surgeons. Conclusion: Prolapse surgery completed by a surgeon is linked with lower odds of 30-day postoperative-complications than the one performed by the obstetrician-gynecologist. Keywords: Outcome, Pelvis surgery, Prolapse surgery, Complication

VAGINAL ELECTROSTIMULATION THERAPY IN THE SYMPTOMS OF WOMEN WITHOVERACTIVE BLADDER

Objective: To describe the results of patients with overactive bladder managed by means of vaginal electrostimulation. Material and Methods: A descriptive study was carried out using as a basisinformation on the file of all patients treated for overactive bladderwith vaginal electrostimulation, from the period from January of 2014 to January of 2019. The therapy consisted on the application of vaginal electrostimulation for 12 30 minutes sessions. A decrease in urination frequency was determined (7.67 vs 647, p=0.001),in urinary urgency (2.07 vs 1.53, p= 0.001)and in nocturia (1.6 vs 1.02 p= 0.001). The multivariate analysis allowed us to observethat in the case of nocturia, the history of previous pelvic surgery and diseasehad a positive interaction (Previous pelvic surgery, 9.07 p=0.008and Chronic disease, 5.54 P=0.047). Discussion: The use of electrostimulation for the treatment of overactive bladder in women presents favorable results, but we must consider the history of previous surgery and comorbidities of the patients in their management.

Preoperative T and N Restaging of Rectal Cancer After Neoadjuvant Chemoradiotherapy: An Accuracy Comparison Between MSCT and MRI.

BackgroundIt is well established that magnetic resonance imaging (MRI) is better than multi-slice computed tomography (MSCT) for the accurate diagnosis of pretreatment tumor (T) and node (N) staging of rectal cancer. However, the diagnostic value of MRI and MSCT in local restaging of rectal cancer after neoadjuvant chemoradiotherapy (NCRT) is controversial. The aim of this study is to investigate the performance of the two imaging exams in restaging of patients with rectal cancer.MethodsPatients with rectal cancer from April 2015 to April 2021 were analyzed retrospectively. The inclusion criteria are as follows: 1) diagnosis of rectal cancer through pathology; 2) NCRT had been performed; 3) all patients had undergone both MSCT and MRI examination before the surgery. Exclusion criteria are as follows: 1) incomplete clinical and imaging data; 2) previous history of pelvic surgery. Two radiologists performed T and N staging of patient images. Diagnostic accuracy, consistency analysis, and error restaging distribution of the two imaging exams for T and N restaging of rectal cancer were assessed using postoperative pathological staging as the gold standard.ResultsA total of 62 patients (49 men; mean age: 59 years; age range 29–83 years) were included in the study. The diagnostic accuracy of MSCT and MRI for T restaging was 51.6% (95% CI 39.3%–63.9%) and 41.9% (95% CI 29.6%–54.2%), respectively, and no statistical difference was found between them (p > 0.05). The diagnostic accuracy of MSCT and MRI for N restaging was 56.5% (95% CI 44.2%–68.8%) and 53.2% (95% CI 40.8%–65.6%), respectively, and no statistical difference was found between them (p > 0.05). The consistency analysis showed that T restaging (κ = 0.583, p < 0.001) and N restaging (κ = 0.644, p < 0.001) were similar between MSCT and MRI. There was no significant difference in the distribution of over, accurate, or low staging in T restaging (p > 0.05) and N restaging (p > 0.05) between MSCT and MRI.ConclusionsMSCT and MRI have similarly poor performance in the diagnosis of preoperative T and N restaging of rectal cancer after NCRT. Neither of them cannot effectively stage the ypT0-1 of rectal cancer. These findings may be of clinical relevance for planning less imaging exam.

Hanging bladder stone due to misplaced surgical suture several years after hysterectomy: A case report.

Introduction and importanceUrinary bladder calculi are rarely seen in women and any history of previous pelvic surgery must, therefore, raise suspicion of an iatrogenic etiology. The incidence of iatrogenic foreign bodies rise recently due to increasing number of surgical procedure. According to the literature, fewer than 2% of all bladder calculi occur in female subjects and, thus, their presence should provoke careful assessment of the etiology. There have been a number of reports on bladder calculi in women with a history of gynecologic procedures. We report a case of bladder calculus after hysterectomy that was treated successfully by open surgery.Case presentationA 54 year old lady with dysuria, had a history of urinary stone for one last year. She was complaining hematuria. She had radical hysterectomy 20 years ago and cystoscopy Lithotripsy because of bladder stone a year ago. Physical examination was unremarkable. Abdominal CT scan with contrast had revealed multiple vesicolithiasis and irregular calcifications attached to the superior aspect of vesical urinary.Clinical discussionCystoscopic evaluation was performed and confirmed presence of calculi forming around several surgical sutures fixed to the bladder wall. The intravesical calculus had developed from non-absorbable sutures and hung on the dome of the urinary bladder. The stone and residuum of the suture were retrieved by performing an open surgery.ConclusionThe presence of an intravesical stone should be suspected in patients with a history of hysterectomy who have symptoms in the lower urinary tract. A hanging stone on the dome of the urinary bladder implies that non absorbable suture materials intrusion into the urinary bladder. The complication can be prevented by the routine use of absorbable material and doublechecking with cystoscopy.

Comparison on efficacy between fascia-oriented versus vascular-oriented lateral lymph node dissection in patients with rectal cancer

Objective: To compare the postoperative function, the short-term and long-term outcomes between fascia-oriented and vascular-oriented lateral lymph node dissection (LLND) in patients with rectal cancer. Methods: A retrospective cohort study was performed. Clinical data of patients who received total mesorectal excision (TME) with LLND at National Cancer Center, Cancer Hospital of Chinese Academy of Medical Science from January 2014 to December 2019 were retrospectively collected. Inclusion criteria were as follows: (1) rectal cancer was pathologically diagnosed, and the lower margin was below the peritoneal reflection. (2) resectable advanced rectal cancer with suspected lateral lymph node metastasis was evaluated based on rectal MRI assessment. (3) preoperative MRI showed lateral lymph node short diameter ≥5 mm and/or lymph node morphology (spike, blur, irregular) as well as heterogenous signal intensity. Lymph node shrinkage was less than 60% after receiving neoadjuvant therapy based on the reassessment of rectal MRI. (4) TME+LLND surgery was performed synchronously. Exclusion criteria were as follows: (1) previous history of pelvic surgery; (2) preoperative cystitis, urethritis, moderate and severe prostatic hyperplasia and other diseases resulting in abnormal urination function; (3) preoperative sexual dysfunction or loss of function; (4) patients receiving LLND due to lateral recurrence after TME; (5) distant metastasis of the tumor at initial diagnosis; (6) Incomplete collection of clinical data. A total of 73 consecutive patients were enrolled in this study. Based on the surgical approaches in performing LLND, patients were divided into fascia-oriented group (n=30) and vascular-oriented group (n=43). There were no significant differences in baseline data between the two groups (all P>0.05). The main outcome indicators of this study were the incidence of postoperative urinary and male sexual dysfunction, the efficacy, the number of lateral lymph nodes harvested and the detection rate of positive lymph nodes. Overall survival (OS) rates and progression free survival (PFS) rates were calculated by the Kaplan-Meier method and compared by log-rank test. Results: All patients in both groups completed surgery successfully. There were no significant differences in operation time, intraoperative blood loss, postoperative complications, and the length of hospital stay between the two groups (all P>0.05). In the whole group, the incidence of postoperative urinary dysfunction and male sexual dysfunction was 43.8% (32/73) and 62.5% (25/40), respectively. The median number of lateral lymph nodes harvested was 8.0(4.0,11.0) with a positive rate of 20.5%(15/73). Compared to the vascular-oriented group, the fascia-oriented group demonstrated a decreased rate of urinary dysfunction [26.7% (8/30) vs. 55.8% (24/43), χ(2)=6.098, P=0.014], lower rate of sexual dysfunction in males [6/15 vs. 76% (19/25), χ(2)=5.184, P=0.023], more harvested lateral lymph nodes [M (P25, P75): 9.5 (6.8, 15.3) vs. 6.0 (3.0, 9.0), Z=-2.849, P=0.004]. There was no significant difference in the positvie rate of lateral lymph nodes between the two groups [20% (6/30) versus 20.9% (9/43), χ(2)=0.009, P=0.923]. Three(4.1%) patients were lost during a median follow-up of 34 (1-66) months. The 3-year PFS and OS of the whole cohort were 69.5% and 88.3%, respectively. No significant difference in 3-year PFS rates (79.6% vs. 62.0%, P=0.172) and 3-year OS rates (91.2% vs. 85.9%, P=0.333) were observed between the fascia-oriented group and the vascular-oriented group (both P>0.05). Conclusion: Fascia-oriented LLND is associated with lower risk of postoperative urinary and male sexual dysfunction in patients with rectal carcinoma, and harvest of more lymph nodes, but no significant advantage in long-term survival.

The Effect of Complexity of the Surgical Field on Perioperative Outcomes of Robot-Assisted Radical Cystectomy

ObjectiveTo report the outcomes of patients who underwent robot-assisted radical cystectomy (RARC) and have a history of previous pelvic surgery and/or radiation. MethodsRetrospective review of our prospectively maintained database between 2005 and 2018. Patients were divided into 3 groups based on surgical complexity; Complexity grade 1 included patients who did not have any history of prior pelvic surgery or radiation (n = 323); Complexity grade 2 included those who had history of a single pelvic surgery or radiation (n = 186); and Complexity grade 3 included those who had history of 2 or more pelvic surgeries, or one or more pelvic surgery and radiation (n = 80). All groups were compared in terms of perioperative outcomes. Multivariate linear and logistic regression models were used to depict the predictors of operative time, ≥500 ml blood loss, 90-day complications, high grade complications, and readmissions. ResultsComplexity grades 2 and 3 exhibited higher 90-day complications compared to CG1 (CG3: 74%, CG1: 59%, CG2: 68%, P = .02), and high grade complications (CG3: 24%, CG1: 13%, CG2 18%, P = .03). On multivariate linear and logistic regression models, CG 3 was significantly associated with higher 90-day complications (OR 2.18, 95% CI 1.21-3.94, P <.01) but not significantly associated with higher rates of significant blood loss, longer operative time, 90-day high grade complications and readmissions. ConclusionPatients with higher complexity of the surgical field exhibited more complications after robot-assisted radical cystectomy, but not readmissions.

MP49-02 THE EFFECT OF SURGICAL COMPLEXITY ON PERIOPERATIVE OUTCOMES OF ROBOT-ASSISTED RADICAL CYSTECTOMY

You have accessJournal of UrologyBladder Cancer: Invasive I (MP49)1 Apr 2020MP49-02 THE EFFECT OF SURGICAL COMPLEXITY ON PERIOPERATIVE OUTCOMES OF ROBOT-ASSISTED RADICAL CYSTECTOMY Ahmed Elsayed*, Naif Aldhaam, Zhe Jing, Jennifer Osei, Mohammad Durrani, Zachary Kurbiel, Michael Mostowy, Alat Siam, Tarik Babar, Ahmed Hussein, and Khurshid Guru Ahmed Elsayed*Ahmed Elsayed* More articles by this author , Naif AldhaamNaif Aldhaam More articles by this author , Zhe JingZhe Jing More articles by this author , Jennifer OseiJennifer Osei More articles by this author , Mohammad DurraniMohammad Durrani More articles by this author , Zachary KurbielZachary Kurbiel More articles by this author , Michael MostowyMichael Mostowy More articles by this author , Alat SiamAlat Siam More articles by this author , Tarik BabarTarik Babar More articles by this author , Ahmed HusseinAhmed Hussein More articles by this author , and Khurshid GuruKhurshid Guru More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000911.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Previous surgery and/or radiation can lead to significant intra-abdominal adhesions and therefore, can add to the complexity of surgery, and render minimally invasive surgery more challenging. We hereby report the perioperative outcomes of patients who underwent robot-assisted radical cystectomy (RARC) and have a history of previous pelvic surgery and/or radiation. METHODS: Retrospective review of our prospectively maintained database between 2005 and 2018. 589 RARCs were identified. Patients were divided into three groups based on surgical complexity; Complexity grade 1 (CG1) included patients who did not have any history of prior pelvic surgery or radiation (n=323); Complexity grade 2 (CG2) included those who had history of a single pelvic surgery or radiation (n=186); and Complexity grade 3 (CG3) included those who had history of 2 or more pelvic surgeries, or one or more pelvic surgery and radiation (n=80). All groups were compared in terms of perioperative characteristics and pathologic outcomes. Multivariate linear and logistic regression models were used to depict the predictors of operative time, ≥500 ml blood loss, 90-day complications, high grade complications, and readmissions. RESULTS: Mean age was 69 ± 11 years with a median follow up of 52 months. CG 3 were more likely to have an ASA ≥3 (CG3: 72% vs CG1: 49% and CG2: 59%, p<0.01), less likely to receive neobladder (CG3: 3% vs CG1: 13%, vs CG2: 6%, p<0.01), more 90-day complications compared (CG3: 74%, CG1: 59%, CG2: 68%, p=0.02), and more high grade complications (CG3: 24%, CG1: 13%, CG2 18%, p=0.03). On multivariate linear and logistic regression models, CG 3 was significantly associated with higher 90-day overall complications (OR 2.18, 95% CI 1.21-3.94, p<0.01) but not estimated blood loss, longer operative time, 90-day high grade complications and readmissions (Table 1). CONCLUSIONS: Higher surgical complexity was associated with higher overall complications, but not estimated blood loss, longer operative time, high grade complications and readmissions. Source of Funding: Roswell Park Alliance Foundation © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e739-e739 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ahmed Elsayed* More articles by this author Naif Aldhaam More articles by this author Zhe Jing More articles by this author Jennifer Osei More articles by this author Mohammad Durrani More articles by this author Zachary Kurbiel More articles by this author Michael Mostowy More articles by this author Alat Siam More articles by this author Tarik Babar More articles by this author Ahmed Hussein More articles by this author Khurshid Guru More articles by this author Expand All Advertisement PDF downloadLoading ...

Latent Genital Tuberculosis – A Causative Factor for Ectopic Pregnancy- A Retrospective Analysis

Background: Ectopic tubal pregnancy (ETP) is a dreadful situation for both the patient and the doctor. Prevalence of ETP is increasing because of availability of convenient and modern modalities for the diagnosis of ectopic pregnancy. Patients are aware of the condition and many lives can be saved when diagnosed and managed at an early stage; still almost 10% of maternal deaths are due to ETP. The etiology of ETP remains unknown in almost half of the cases and hence the risk of recurrence remains high. The present study has been conducted to screen patients with history of tubal ectopic pregnancyand to determine the role of tubercular infestation of the eutopicendometrium as an important etiological factor in ‘unexplained’ ectopic. Results: This retrospective analysis was conducted at Calcutta Fertility Mission in Kolkata, India, from January 2010 to December 2018. Of 282 patients with history of ETP,who were selected, 109 were in Group A, 72 of them in Group B and 101 in Group C. Tubercular infestation of the endometrium (DNA-PCR positive) was found in all (109) patients in Group A, and others in Group B and C had previous history of pelvic surgery or endometriosis, pelvic infection or unexplained infertility associated with tubercular infestation of the endometrium. In our study latent genital tuberculosis has been proved to be a statistically significant factor for ETP. (p value - &lt;0.001) Moreover other factors like tubal surgeries (p value - &lt;0.001) or correction of minor tubal defects (p value – 0.024); endometriosis (p value- &lt;0.001) and pelvic inflammatory disease (p value -&lt;0.001), have shown statistical significance in causing ectopic pregnancy. Clinical pregnancy rate (p value -0.002) and live birth rate (p value-&lt;0.001) has been proved to be statistically significant after treatment of ETP. Conclusion: Along with the documented causes of ETP tubercular infestation of the endometrium should be considered as an important etiology for ectopic pregnancy and should be screened on a routine basis for early intervention and treatment.

Laparoscopic hysterectomy experience and learning curve: in our clinic

Objective: The aim of this article is to compare the perioperative results of 30 laparoscopic hysterectomies (LH) and 62 LH operations performed on patients in similar age groups and demographic characteristics. Method: A total of 92 patients who were operated between September 2013 and June 2015 in our clinic were included in the study. Group 1 was formed with the first 30 patients who underwent LH surgery for the first time. Group 2 was formed with 62 patients. Results: No statistically significant difference was found between the patients in Group 1 and Group 2 in terms of age, number of parity and previous pelvic surgery history (p = 0.845; p = 0.266, and p = 0.796). There was also no statistically significant difference between the patients in Group 1 and Group 2 in terms of operation time (min.), Delta Hb (gr / dl), hospitalization time (day) and complication rate (p = 0.198; p = 0.486; p = 0.201, and p = 0.454). Conclusions: Although laparoscopic hysterectomy is an operation method with low complication rates and high patient satisfaction, it should be kept in mind that increased surgical experience does not always guarantee good perioperative results.

Uretero-iliac artery fistula: a challenge diagnosis for a life-threatening condition: monocentric experience and review of the literature.

Uretero-iliac artery fistulae (UIAF) are the consequence of chronic inflammatory events that create a fibrous and poorly vascularized uretero-vascular adhesion. They often occur in patients with a history of surgery, pelvic radiotherapy, and chronic ureteral stenting. The presentation is usually massive gross hematuria with acute anemia unto to hemorrhagic shock, representing a life-threatening condition. High mortality rate is reported (7-23%). We present four cases in three patients, treated in our Institution from 2013 to 2018, and reviewed the published literature. UIAF was defined as the ratified presence of an abnormal communication between the ureter and any artery. In all patients, the UIAF was initially evaluated by contrast-enhanced computed tomography (CT) angiography. The management strategy was defined individually based on the specific risk profile of each patient. In all cases, ureteral-iliac artery fistula occurred in female patients with previous surgery or radiation and with presence of indwelling ureteral stent. In every case the hematuria was massive and life-threatening. Diagnosis was delayed because of the poor diagnostic accuracy of CT scan, leading to over-treatment. Angiography resulted the best diagnostic tool. The endovascular treatment proved good outcomes in terms of early complications, with no case of mortality. In case of gross hematuria during ureteral stent change in female patients with history of previous pelvic surgery and radiation, UIAF must be suspected and immediately treated, since it represents a urological emergency. Angiography can be useful to confirm the diagnosis and endovascular treatment with vascular endoprosthesis is the best therapeutic option.

Primary umbilical endometriosis: To scope or not to scope?

Background. Primary umbilical endometriosis (PUE) is a rare condition affecting 0.5 - 1% of all cases of extragenital endometriosis. The method of using routine laparoscopic inspection of the pelvis to exclude pelvic endometriosis has been applied extensively over the years. It has been demonstrated that even patients who have had no previous pelvic surgery or caesarean section, and have no symptoms of pelvic endometriosis or history of infertility, have presented with this condition. Objective. To investigate whether patients with PUE should always undergo a laparoscopy to exclude pelvic endometriosis. Methods. The study included women presenting with a history of painful umbilical nodules or bleeding from the umbilical nodule during or after menstruation in the absence of previous surgery either for gynecological disorders or caesarean section. The study began in January 2010 and ended in December 2016. All patients underwent umbilical biopsy confirming the presence of umbilical endometriosis before the diagnostic laparoscopy took place. Results. Fourteen patients with cutaneous (scar) and umbilical endometriosis attended the clinic during the study period. Of these, only six cases (42.8%) met the inclusion criteria of PUE clinically, and underwent diagnostic laparoscopy. Their mean age was 31.1 years (range 23 - 48), and the mean parity was 1.1 (range 0 - 3), with no history of previous pelvic surgery or caesarean section. Biopsies of the lesions confirmed the presence of endometrial tissue (gland and stroma) and haemorrhage. Diagnostic laparoscopy that took place immediately after the excision of umbilical endometriosis revealed no pelvic endometriosis. Conclusion. A laparoscopy to exclude pelvic endometriosis should not be undertaken in patients who present with PUE, as there is a potential risk of introducing endometriosis into the pelvic cavity. Additionally, there is a risk of exposing the patient to unnecessary intervention and possible complications associated with the procedure.

Cutaneous endometriosis: to scope or not to scope?

Background: Cutaneous endometriosis occurs in a surgical scar following abdominal or pelvic procedures. The incidence of scar endometriosis has been estimated to be only 0.03-0.15% of all cases of endometriosis. The tendency to use routine laparoscopic inspection of the pelvis to exclude concurrent pelvic endometriosis has been applied extensively over the years. Aim of the study: The aim of this study was to investigate if patients with cutaneous endometriosis should always undergo laparoscopy to exclude pelvic endometriosis. Material and methods The study included women presenting with a history of painful nodules at either the umbilicus, a midline incision or at the level of a Pfannenstiel scar, following gynecological or caesarean section procedures. The lesion may have been slightly tender around the time of menstruation. Bleeding from the umbilical or scar nodule during or after menstruation was also described by some patients. The study began in January 2010 and ended in December 2016. All patients underwent umbilical or scar nodule biopsy confirming the presence of endometriosis before the diagnostic laparoscopy took place. Results: Fourteen patients with cutaneous (scar) and umbilical endometriosis attended the clinic during the study period. Out of these, only eight cases (47.2%) met the inclusion criteria of scar endometriosis clinically and underwent diagnostic laparoscopy. The mean age was 35.6 years (29-47) and mean parity was 1.5 (0-3), with a history of previous pelvic surgery or caesarean sections. Biopsy of the lesion confirmed the presence of endometrial tissue (gland and stroma) and haemorrhage. Diagnostic laparoscopy, after the excision of umbilical or scar endometriosis, revealed no pelvic endometriosis. Conclusion: A laparoscopy to exclude pelvic endometriosis should not be undertaken in patients who present with scar endometriosis, as there is a potential risk of introducing endometriosis into the pelvic cavity.

The Aging Bladder in Females Evaluated by Urodynamics

Aim: To determine whether bladder functions deteriorate with age. Methods: Data contained in electronic medical record (INFOMED?) were used in this institutional retrospective review. Analysis was done on the urodynamic studies in women over 18 years old conducted between May 2011 and November 2015. Patients with previous history of pelvic surgery or radiotherapy, neurological disease, vaginal prolapse greater than grade I, congenital urogenital malformations, urinary obstructive disease, diabetes, or the use of any medication that could interfere with bladder function were excluded from the analysis. The urodynamic parameters analyzed were the Maximum Cystometric Capacity (MCC), Voiding Volume (VV), Maximum Flow (Qmax), Bladder Compliance (BC), Detrusor Pressure at Maximum Flow (PdetQmax), Bladder Contractility Index (BCI), Bladder Voiding Efficiency (BVE) and Post-Void Residual Urine Volume (PVR). Patients were further stratified in five groups according to age (A—18 to 40; B—41 to 50; C—51 to 60; D—61 to 70; E—over 70 years old). Results: Out of 3103 urodynamic studies analyzed, 719 were eligible for the study. The average age of patients was 49.3 (+13.2) years old and in all evaluated parameters, statistically significant correlation between age and decline of bladder function was obtained (p < 0.05). Moreover, mathematical equations were presented to estimate the parameters values in relation to age. Conclusions: This study showed a decline in bladder storage function (reduction in MCC and BC) and in bladder emptying function (reduction in Qmax, PdetQmax, VV, BCI and BVE with an increase in PVR) with age.

Intersticial ectopic pregnancy – cases report

Introduction: Ectopic pregnancy is an important cause of morbidity and mortality during the 1st trimester of pregnancy. The interstitial pregnancy is a rare disease, and it happens when a pregnancy is implanted in the intersticial part of the Fallopian Tube, which is the proximal portion of the tube that is within the muscular wall of the uterus. This type of ectopic pregnancy is a rare entity, accounting for 2–4% of all tubal pregnancies, but the reported maternal mortality is in the range of 2–2.5% Methods: Review of two cases of intersticial ectopic pregnancies occurred in 2015 in Centro Hospitalar Leiria. Clinical cases or summary results: (1) 38 year old woman, G2P1 (cesarean section in 2013), comes to the emergency department refering a narrow vaginal bleed with five weeks of amenorrhea. Had human chorionic gonadotropin (β-hCG) of 877 mUI/mL and showed in the ultrasound a heterogeneous endometrium with 17 mm thick without identification of any embryonic structures and no fluid in the Douglas’ pouch. A week later her β-hCG in the serum was of 4177 mUI/mL and the pelvic ultrasound shows an image within the fundus/left horn compatible with an ectopic pregnancy. The patient was submitted to diagnostic laparoscopy followed by left cornual resection and left salpingectomy by laparotomy. Histological studies of the fragment showed signs of decidualization and tissue invasion by trophoblast. 2. 27 year old woman, G4P1 (cesarean section in 2014), sent by the Reproductive Health Consult with the diagnosis of ectopic pregnancy. The ultrasoud showed near the left horn of the uterus a econegative image with peripheral vasculature and deciduous reaction with about 31 mm × 23 mm. Conclusion: The described clinical cases were treated surgically, reducing the likelihood of relapse, and both cases had only as risk factor a history of previous pelvic surgery. None of the patients had acute abdominal hemorrhage or was ever hemodynamically unstable.

Effectiveness and success rate of medical management of ectopic pregnancy in Latifa Hospital (2010–2013), Dubai, UAE

Aim: To evaluate the effectiveness of medical treatments of ectopic pregnancy which conserves the patient's reproductive potential. Materials and methods: Retrospective study carried out on patients with ectopic pregnancy who were admitted to gyne ward in Latifa Hospital, Department of Obstetrics & Gynecology, a tertiary care hospital in Dubai over a period of 3 years from January 2010 to December 2013 and were treated with MTX injection (using single dose regimen 50 mg/m2 body surface area) with follow up of βhCG in day 7 and 2nd dose of MTX was given for those with increased, persistent level of βhCG, or for those whom βhCG level failed to decrease >15%. Success criteria was resolving of ectopic pregnancy with no surgical intervention (although for scar pregnancy ERPOC done for some cases but this was considered minor procedure). Failure criteria was need for either laparotomy or laparoscopic salpingectomy. Microsoft Excel was used for statistical analysis and for presentation of the data in the form of tables and graphs. Continuous variables are reported as means with standard deviation. Categorical variables are reported as percentages. Chi-square test, T-test, Z-test for 2 sample proportions and Mann–Whitney U-value were used to compare between categorical variables. P values of <0.05 are used for statistical significance. Results: There were a total of 115 patients with ectopic pregnancy who received MTX in Latifa Hospital from the period of 1st January 2010 to 31st December 2013. 70 (60.9%) patients had successful MTX treatment and 32 (27.8%) patients had failed MTX treatment, while 13 (11.3%) patients had no follow up. 70 patients, 23 (20%) patients were diagnosed as pregnancy of unknown location. 63 (54.8%) patients had only adnexal mass without free fluid in POD, while 20 (17.4%) patients had both adnexal mass & mild free fluid in POD, scar pregnancy was seen in 9 (7.8%) patients. There was 3 viable scar pregnancies while there was no viable adnexal mass included, there was no difference in the success rate of MTX treatment in relation to size or site of ectopic mass. The mean maternal age in our study was 30.2 years ± 5.4 (SD), MTX treatment success was more with higher age group. 103 (89.6%) patients conceived spontaneously, 8 (6.9%) patients conceived after ovulation induction treatment either by oral Clomiphene or by injections and 4 (3.5%) underwent assisted reproductive techniques. there was no difference in the success rate of MTX treatment with different groups. Most common risk factor was history of previous pelvic surgery and success was more with patients who have this risk factor. Patients who presented with abdominal pain and tenderness had higher failure rate than those who were asymptomatic. Those with low level of βhCG pretreatment and whom βhCG level decreased >15% in day 7 post-treatment had higher success rate. Conclusion: EP is a common and serious problem with both high maternal morbidity and mortality. Systemic MTX should be considered as the first line treatment in hemodynamically stable women with an intact ectopic pregnancy especially for those with the desire to preserve fertility. Asymptomatic patients had higher success rate of MTX treatment than patients with abdominal pain and tenderness. Low level of βhCG pretreatment and decrease the level >15% in day 7 post-treatment are considered predictive factors for the success of MTX treatment in EP.

Predictive factors of uterine movement during definitive radiotherapy for cervical cancer.

To determine the predictive factors affecting uterine movement during radiotherapy (RT), we quantified interfraction uterine movement using computed tomography (CT) and cone-beam CT (CBCT). A total of 38 patients who underwent definitive RT for cervical cancer were retrospectively analyzed. We compared pre-RT planning CT (n = 38) and intratreatment CBCT (n = 315), measuring cervical and corporal movement in each direction. Correlations between uterine movement and volume changes of the bladder and rectum on all CBCT scans were analyzed using Spearman rank correlation analysis. Relationships between the mean uterine movement and patient factors were analyzed using the Mann–Whitney test. The mean corpus movement was: superior margin (cranio–caudal direction), 7.6 ± 5.9 mm; anterior margin (anteroposterior direction), 8.3 ± 6.3 mm; left margin (lateral direction), 3.3 ± 2.9 mm; and right margin (lateral direction), 3.0 ± 2.3 mm. Generally, the mean values for cervical movement were smaller than those for the corpus. There was a significant, weak correlation between changes in bladder volume and the movement of the superior margin of the corpus (ρ = 0.364, P < 0.001). There was a significant difference in movement of the superior margin of the corpus between the subgroups with and without a history of previous pelvic surgery (P = 0.007). In conclusion, change in bladder volume and a history of previous surgery were significantly related to intrafractional corpus movement; however, our observations suggest that the accurate prediction of uterine movement remains challenging.

Association Between Endometriosis and Tubo-Ovarian Abscess

Background: Tubo-ovarian abcesses (TOAs) are complicating factors in approximately one-fourth of hospitalized cases of acute pelvic inflammatory disease (PID). However, many women with TOAs have no antecedent history of PID or sexually transmitted diseases. Moreover, it has not been fully elucidated that which risk factors are associated with TOA and TOAs will develop at whom. In recent studies, it has been questioned whether endometriosis is a risk factor for TOA. The purpose of the study was to identify the incidence of endometriosis in patients who have been surgically treated due to TOA and to search clinical-demographical differences among the groups with and without endometriosis. Methods: A total of 118 patients were divided into two groups according to pathologic results, whether endometriosis with TOAs was confirmed histologically, or not, and demographical-clinical characteristics were investigated. Results: The mean age of patients was 40.9 ± 8.5 years and 21 (17.8%) were postmenopausal. The intrauterine device was in situ at the time of TOA diagnosis in 49 (41.5%) patients. Concomitant disease and previous pelvic surgery history were identified in 16 (13.6%) and 43 (36.4%) patients, respectively. Final histopathological analyses revealed endometriosis with TOA in 21 (17.8%) patients. When all patients were divided into two groups with and without endometriosis and compared according to clinical and demographical characteristics, there were not any significant differences identified (P > 0.05), except hemoglobin values (P = 0.039). Conclusion: Endometriosis with TOA is not only in reproductive period but also in menopause, more prevalent than expected for normal population. J Clin Gynecol Obstet. 2016;5(1):17-22 doi: http://dx.doi.org/10.14740/jcgo388w

Our experience in laparoscopic hysterectomy: A single center experience

Objective: The aim of this study is to compare the perioperative outcomes of first 30 Laparoscopic Hysterectomy operations (LH) with the subsequent ones in patients similar with basic demographic characteristics. Methods: A total of 92 patients operated in Bucak State Department of Obstetrics and Gynecology and Duzce University Hospital, Faculty of Medicine, Department of Obstetrics and Gynecology between January 2012 and October 2013 were included in this study. LH operations performed for the first time by the same surgeon in 30 patients were formed Group 1. The remaining 62 patients, operated after the first 30 patients were formed Group 2. Results: No statistically significant difference was detected in terms of age, parity, and previous history of pelvic surgery between Group 1 and Group 2 (p =0.813, p = 0.706 and p = 0.410). There was not any statistically significant difference between Group 1 and Group 2 in terms of operation time (min.), delta hb (g/dl), hospitalization time (day), and complication rate (p = 0.197 and p = 0.085, p = 0.086 and p = 0.353). Conclusion: As today LH is a promising method of operation with low complication rates and high patient satisfaction, it should be kept in mind that increased surgeon experience does not always assure good surgical outcome.

Ectopic Ovary: One New Location

Ectopic ovarian tissue is a rare gynecologic condition. Accessory ovaries were defined as excess ovarian tissue adjacent and connected to a normal ovary, while supernumerary ovaries were described as those ovaries situated away from normal ones. The one presented here is a case of a 20 year-old unmarried woman operated for recurrent abdominal pain. During laparoscopy we found a mass 2 × 1.5 cm in size in the ileum, located 80 cm from the ileocecal valve: the lesion was resected and an ileoileal anastomosis was performed, the anatomopathological examination of the mass proved to be ovarian tissue. The history of previous pelvic surgery with adhesiolysis, and the unusual location of the ectopic ovary, support the theory of an ovarian implant in the intestine, but the true ectopic ovary hypothesis is still probable because of the location of the ectopic ovary inside the intestinal wall. In any case, the location of ectopic ovary discussed here is unusual and perhaps unpublished before.

Iatrogenic lower urinary tract injury at the time of pelvic reconstructive surgery: does previous pelvic surgery increase the risk?

The objective of this study was to evaluate whether a history of previous pelvic surgery is associated with lower urinary tract (LUT) injury at the time of pelvic reconstructive surgery (PRS). A retrospective analysis of patients undergoing pelvic reconstructive surgery from 2006 to 2011 was performed. Patients were divided into two groups: those with previous pelvic surgery and those without previous pelvic surgery. A sample size analysis was performed to determine the number needed to detect at least a 3-fold difference in the rate of LUT injury. Demographic, historical, clinical, intraoperative, and postoperative data were analyzed. Associations between LUT injury and demographics, previous pelvic surgery, or other clinical risk factors were assessed using univariate and multivariate analyses. 685 women were included in the analysis: 514 (74.9%) with and 171 (25.1%) without prior pelvic surgery. The overall rate of LUT injury was 6%. Of the injuries, 3.2% were cystotomies, and 1.9% were ureteral obstructions. Previous pelvic surgery did not significantly affect the rate of LUT injury (OR 0.76, 95%CI 0.38-1.54). A diagnosis of prolapse, concurrent hysterectomy, anterior repair, and apical repair were significantly associated with LUT injury. After controlling for age and race, a diagnosis of prolapse remained significantly associated with LUT injury (OR 3.38, 95% CI 1.11-14.75). Prior pelvic surgery does not affect the rate of LUT injury in pelvic reconstructive surgery. The diagnosis of prolapse is a risk factor for LUT injury in women undergoing pelvic reconstructive surgery.