Hysterectomy For Benign Gynecologic Indications Research Articles

Predictors of same-day discharge following benign minimally invasive hysterectomy

Same-day discharge following minimally invasive hysterectomy has been shown to be safe and feasible in select populations, but many nonclinical factors influencing same-day discharge remain unexplored. To develop prediction models for same-day discharge following minimally invasive hysterectomy using both clinical and nonclinical attributes and to compare model concordance of individual attribute groups. We performed a retrospective study of patients who underwent elective minimally invasive hysterectomy for benign gynecologic indications at 69 hospitals in a statewide quality improvement collaborative between 2012 and 2019. Potential predictors of same-day discharge were determined a priori and placed into 1 of 7 attribute groupings: intraoperative, surgeon, hospital, surgical timing, patient clinical, patient socioeconomic, and patient geographic attributes. To account for clustering of same-day discharge practices among surgeons and within hospitals, hierarchical multivariable logistic regression models were fitted using predictors from each attribute group individually and all predictors in a composite model. Receiver operator characteristic curves were generated for each model. The Hanley-McNeil test was used for comparisons, 95% confidence intervals for the areas under the receiver operator characteristic curve were calculated, and a P value of <.05 was considered significant. Of the 23,513 patients in our study, 5062 (21.5%) had same-day discharge. The composite model had an area under the receiver operator characteristic curve of 0.770 (95% confidence interval, 0.763-0.777). Among models using factors from individual attribute groups, the model using intraoperative attributes had the highest concordance for same-day discharge (area under the receiver operator characteristic curve, 0.720; 95% confidence interval, 0.712-0.727). The models using surgeon and hospital attributes were the second and third most concordant, respectively (area under the receiver operator characteristic curve, 0.678; 95% confidence interval, 0.670-0.685; area under the receiver operator characteristic curve, 0.655; 95% confidence interval, 0.656-0.664). Models using surgical timing and patient clinical, socioeconomic, and geographic attributes had poor predictive ability (all areas under the receiver operator characteristic curve <0.6). Clinical and nonclinical attributes contributed to a composite prediction model with good discrimination in predicting same-day discharge following minimally invasive hysterectomy. Factors related to intraoperative, hospital, and surgeon attributes produced models with the strongest predictive ability. Focusing on these attributes may aid efforts to improve utilization of same-day discharge following minimally invasive hysterectomy.

Patient and Hospital Characteristics Associated with Minimally Invasive Hysterectomy. Evidence from 143 Illinois Hospitals, 2016-2018.

Study Objective To identify patient and hospital characteristics associated with minimally invasive (MIS) hysterectomy. Design Retrospective population-based analysis of administrative data. Setting Data from the Illinois Hospital Association Comparative Health Care and Hospital Data Reporting Services Database. Patients or Participants Women undergoing hysterectomy for benign gynecologic indications in Illinois, 2016-2018. Interventions None. Measurements and Main Results We determined the significance of the proportion of MIS versus abdominal hysterectomies by patient and hospital characteristics. Multivariable logistic regression was used to determine the association between patient and hospital characteristics and the likelihood of MIS versus abdominal hysterectomy controlling for the simultaneous effects of all patient and hospital characteristics and year of surgery. There were 42,945 hysterectomies for benign indications at 143 non-federal Illinois hospitals from 2016-2018. Over three quarters (32,387, 75.4%) of hysterectomies were MIS. Non-Hispanic Black patients had the lowest percentage of MIS (54.7%) compared to 82.1% among Whites (p <0.001). Being non-Hispanic Black (OR=0.53, 95% CI 0.47-0.60), Other/unknown race and ethnicity (OR=0.76, 95% CI 0.52-0.85), or having a diagnosis of fibroids (OR=0.54, 95% CI 0.49-0.60) were associated with lower likelihood of MIS. Patients treated at hospitals with >80% MIS, had almost six times the likelihood of MIS (OR=5.89, 95% CI 4.51-7.68). Conclusion Black race and a fibroid diagnosis are independently associated with decreased odds of undergoing MIS hysterectomy, while the strongest predictor of undergoing MIS hysterectomy was hospital proportion of minimally invasive procedures. To identify patient and hospital characteristics associated with minimally invasive (MIS) hysterectomy. Retrospective population-based analysis of administrative data. Data from the Illinois Hospital Association Comparative Health Care and Hospital Data Reporting Services Database. Women undergoing hysterectomy for benign gynecologic indications in Illinois, 2016-2018. None. We determined the significance of the proportion of MIS versus abdominal hysterectomies by patient and hospital characteristics. Multivariable logistic regression was used to determine the association between patient and hospital characteristics and the likelihood of MIS versus abdominal hysterectomy controlling for the simultaneous effects of all patient and hospital characteristics and year of surgery. There were 42,945 hysterectomies for benign indications at 143 non-federal Illinois hospitals from 2016-2018. Over three quarters (32,387, 75.4%) of hysterectomies were MIS. Non-Hispanic Black patients had the lowest percentage of MIS (54.7%) compared to 82.1% among Whites (p <0.001). Being non-Hispanic Black (OR=0.53, 95% CI 0.47-0.60), Other/unknown race and ethnicity (OR=0.76, 95% CI 0.52-0.85), or having a diagnosis of fibroids (OR=0.54, 95% CI 0.49-0.60) were associated with lower likelihood of MIS. Patients treated at hospitals with >80% MIS, had almost six times the likelihood of MIS (OR=5.89, 95% CI 4.51-7.68). Black race and a fibroid diagnosis are independently associated with decreased odds of undergoing MIS hysterectomy, while the strongest predictor of undergoing MIS hysterectomy was hospital proportion of minimally invasive procedures.

Patient and Hospital Characteristics Associated with Minimally Invasive Hysterectomy: Evidence from 143 Illinois Hospitals, 2016 to 2018

To identify patient and hospital characteristics associated with minimally invasive hysterectomy. Retrospective population-based analysis of administrative data. Data from the Illinois Hospital Association Comparative Health Care and Hospital Data Reporting Services Database. Women undergoing hysterectomy for benign gynecologic indications in Illinois, 2016 to 2018. None. We determined the significance of the proportion of minimally invasive surgery (MIS) versus abdominal hysterectomies by patient and hospital characteristics. Multivariable logistic regression was used to determine the association between patient and hospital characteristics and the likelihood of MIS versus abdominal hysterectomy controlling for the simultaneous effects of all patient and hospital characteristics and year of surgery. There were 42 945 hysterectomies for benign indications at 143 nonfederal Illinois hospitals from 2016 to 2018. More than three-fourths (32 387, 75.4%) of hysterectomies were MIS. Non-Hispanic black patients had the lowest percentage of MIS (54.7%) compared with 82.1% among whites (p <.001). Being non-Hispanic black (odds ratio [OR] = 0.53, 95% confidence interval [CI], 0.47-0.60), other or unknown race and ethnicity (OR 0.76, 95% CI, 0.52-0.85), or having a diagnosis of myomas (OR 0.54, 95% CI, 0.49-0.60) were associated with a lower likelihood of MIS. Patients treated at hospitals with >80% MIS had almost 6 times the likelihood of MIS (OR 5.89, 95% CI, 4.51-7.68). Black race and a myoma diagnosis were independently associated with decreased odds of undergoing an MIS hysterectomy, whereas the strongest predictor of undergoing an MIS hysterectomy was hospital proportion of minimally invasive procedures.

Hysterectomy using a Novel Vaginal Robot

Study Objective The vaginal approach is considered safer than umbilical access in gynecological surgeries. However, despite the growing popularity of robotic surgery, it has not been performed through the vagina. We set out to evaluate the feasibility of vaginal access in robotic surgery. Here we present a case series of the revolutionary technology of robotic vaginal natural orifice transluminal endoscopic surgery (vNOTES), using the Hominis system, on vaginal hysterectomy. Design This is a prospective analysis of hysterectomy performed by robotic vNOTES. 10 women with nonmalignant indications were recruited. Setting Prospective study. Patients or Participants 10 women with nonmalignant indications for hysterectomy were recruited. Interventions Hysterectomy. Measurements and Main Results Two robotic arms were inserted through the posterior fornix. Each arm has built-in mono- and bi-polar capabilities, their actions are controlled by the surgeon sitting at the console a few feet away. Surgical data were collected during the procedures. The median age was 60 years [range: 43-73]; the median BMI was 26 [range: 17-33], the median total operative time was 60 minutes [range: 24-88]. decreasing duration over time indicated a fast learning curve. There were no intraoperative and postoperative adverse events. Conclusion This is the first documentation of a robotic hysterectomy performed via the vagina. Outstanding features of vNOTES include its portability and easy handling due to its light weight (less than 10 pounds), scarless surgery, and access to any part of the abdomen by articulation of the flexible robotic arms. No special maintenance is required. The approach combines the benefits of vaginal procedures and laparoscopic techniques and maintains safety in regard to proximity to pelvic organs. This case series demonstrates the feasibility of using vNOTES for hysterectomy for benign gynecologic indications

2487 Same-Day Discharge after Hysterectomy: Identifying Reasons for Unplanned Admissions and Evaluating Institutional Compliance with a Standardized Protocol

Study Objective Same-day discharge (SDD) has been the goal of most of minimally invasive hysterectomies. Our institution adopted a standardized operating procedure (SOP) for planned SDD in 2013. The aims of this study were to identify the reasons for unplanned admissions after minimally invasive hysterectomies at our institution and critically review the SDD SOP. Design Quality assurance, retrospective cohort study Setting Single academic institution Patients or Participants We reviewed charts of 74 patients between January to June 2017 and from June to December 2018 who underwent minimally invasive hysterectomy for benign gynecologic indications. Urogynecology patients were excluded. Interventions No interventions, descriptive study. Measurements and Main Results The peri-operative hospital course our sample was compared to our institution's SOP for same-day discharge. The average age of our cohort was 44 with an average body mass index of 27. Mean post-operative acute care unit stay was 4.7 hours (range 2.5 - 11.1 hours); 34% of patients stayed less than the 4 hours required in the SDD SOP, but none of these patients had post-operative emergency room visits or hospital re-admissions. Documentation of SDD SOP-recommended pre-operative counseling (43%) and intra-operative bladder backfilling (8%) was poor. Unplanned admissions on the day of surgery occurred in 17 (22.9%): 9 (52.9%) were for medical (23.5%) or surgical (29) complications, while 2 (12%) had voiding dysfunction and 2 (12%) had pain. Age, hysterectomy route, length of surgery, and estimated blood loss were not associated with these unplanned admissions. Conclusion Our quality assurance project identified that our unplanned admissions for nausea and pain could potentially be avoided with implementation of enhanced recovery after surgery protocol, including pre-operative counseling of expectations and same-day discharge information. Voiding dysfunction requiring admission could be decreased by performing active voiding trials in recovery area. Consider creating a protocol for goals at recovery room before discharge instead of a time frame to discharge.

Utilization and Outcomes of Ovarian Conservation at Hysterectomy for Benign Gynecologic Indications [15Q

Utilization and Outcomes of Ovarian Conservation at Hysterectomy for Benign Gynecologic Indications [15Q

Delayed recognition of lower urinary tract injuries following hysterectomy for benign indications: A NSQIP-based study

To describe the incidence of and factors associated with lower urinary tract complications recognized in the immediate postoperative period following hysterectomy for benign gynecologic indications using the NSQIP (National Surgical Quality Improvement Program) database. Patients who underwent hysterectomy for benign indications from 2014 through 2016 were identified in the NSQIP database using Current Procedural Terminology codes and International Classification of Diseases codes. Patient demographics, preoperative comorbidities, ASA classification system scores, and total operating time were collected. Data on 30-day postoperative complication rates, including rates of reoperation and readmission, were also captured. Genitourinary complications were defined as ureteral obstruction, ureteral fistula, and bladder fistula. A total of 45,139 patients met inclusion criteria during the study period. Mean age and body mass index were 31 ± 11years and 32 ± 8 kg/m2. The majority of patients were white (66%), had an ASA class of 2 (67%), and had no major medical comorbidities (68%). The most commonly performed primary surgery was laparoscopic hysterectomy (43%), followed by abdominal hysterectomy (27%). The incidence of anylower urinary tract complication was 0.2% (95% confidence interval, 0.19-0.28): 55 ureteral obstructions (0.1%, 95% confidence interval, 0.09-0.16), 33 ureteral fistulae (0.07%, 95% confidence interval,0.05-0.1), and 28 bladder fistulae (0.06%, 95% confidence interval, 0.04-0.09). In a multivariable logistic regression model, black race (adjusted odds ratio, 1.90; 95% confidence interval, 1.20-2.96), endometriosis (adjusted odds ratio, 2.29; 95% confidence interval, 1.44-3.52), and prior abdominal surgery (adjusted odds ratio, 1.53; 95% confidence interval, 1.01-2.28) remained significantly associated with the occurrence of any lower urinary tract complication recognized in the immediate 30-day postoperative window. Lower urinary tract complications recognized in the immediate postoperative period following hysterectomy for benign gynecologic disease are rare, with ureteral obstruction being the most commonly reported complication. The risk of these complications may be higher in patients who identify as black, had prior abdominal surgery, and/or have a diagnosis of endometriosis.

Alternative Treatment Utilization Before Hysterectomy for Benign Gynecologic Conditions at a Large Integrated Health System

To investigate rates of utilization of alternative treatments before hysterectomy for benign gynecologic indications within a large integrated health care system. Retrospective cohort study of patients who underwent hysterectomies for benign gynecologic conditions between 2012 and 2014 (Canadian Task Force classification II-2). Kaiser Permanente Northern California, a community-based integrated health system. Women who underwent hysterectomy for a benign gynecologic condition between 2012 and 2014. From an eligible cohort of 6892 patients who underwent hysterectomy, a stratified random sample of 1050 patients were selected for chart review. Stratification was based on the proportion of indications for hysterectomy. The primary outcome was the use of alternative treatments before hysterectomy. Alternative treatments included oral hormone treatment, leuprolide, medroxyprogesterone intramuscular injections, a levonorgestrel intrauterine device, hormonal subdermal implants, endometrial ablation, uterine artery embolization, hysteroscopy, and myomectomy. Of the 1050 charts reviewed, 979 (93.2%) met the criteria for inclusion in this study. The predominant indication for hysterectomy was symptomatic myomas (54.4%), followed by abnormal uterine bleeding (29.0%), endometriosis (5.8%), pelvic pain (3.1%), dysmenorrhea (3.4%), and other (4.3%). The major routes of hysterectomy were laparoscopy (68.7%) and vaginal hysterectomy (13.4%). Before hysterectomy, 81.2% of patients tried at least 1 type of alternative treatment (33.8% with 1 treatment and 47.4% with at least 2 treatments), and 99.3% of patients were counseled regarding alternative treatments. Compared with younger women age <40 years, women age 45 to 49 years were less likely to use alternative treatments before hysterectomy (adjusted odds ratio, 0.41; 95% confidence interval, 0.21-0.76). There were no variations in treatment rates by socioeconomic status or between major racial and ethnic groups. The final pathological analysis identified myomas as the most common pathology (n = 637; 65.1%); 96 patients (9.8%) had normal uterine pathology. More than 80% of patients received alternative treatments before undergoing hysterectomy for a benign gynecologic condition. Additional investigation is warranted to assess alternative treatment use as it relates to preventing unnecessary hysterectomies.

Practice Patterns and Complications of Benign Hysterectomy Following the FDA Statement Warning Against the Use of Power Morcellation

In November 2014, the US Food and Drug Administration (FDA) issued a black box warning against the use of power morcellation for excision of uterine fibroids to decrease the risk of disseminating malignant cells and worsening survival outcomes of patients with unexpected malignant neoplasms. After the FDA statement was issued, studies showed decreased rates of minimally invasive surgery and increased rates of open abdominal hysterectomy. However, there are limited and controversial data on the association of these changed rates with 30-day hysterectomy complications. To assess changes in the rates of 30-day major and minor complications of hysterectomy for benign gynecologic indications following the FDA-issued statement. This retrospective cohort study used the American College of Surgeons National Surgical Quality Improvement Program database and included 603 hospitals participating between January 1, 2013, and December 31, 2015. Thirty-day posthysterectomy complications were compared before and after the FDA-issued warning. Women who underwent hysterectomy for benign gynecologic indications (n = 75 487), including hysterectomies with indication of uterine fibroids (n = 25 571), were included. Complication rates and procedure distributions between the periods were compared with χ2 tests and multivariable logistic regression controlling for patient and operative factors. Major and minor 30-day complication rates before (from 2013 through the first quarter of 2014) and after (from the fourth quarter of 2014 through 2015) the FDA-issued warning. Of 75 487 women (mean [SD] age, 47.8 [10.7] years) who underwent hysterectomy for benign gynecologic indications, 32 186 (42.6%) were treated before and 43 301 (57.4%) after the FDA-issued warning. Non-Hispanic white women comprised most (59.4%) of the total population, followed by African American women (15.1%). Overall, major and minor complications remained stable before and after the FDA-issued warning. By contrast, among a subset of 25 571 women (33.9%) who underwent hysterectomy for uterine fibroids, major complications significantly increased after the FDA-issued warning from 1.9% to 2.4% (adjusted odds ratio [OR], 1.23; 95% CI, 1.04-1.47; P = .02), and minor complications significantly increased from 2.7% to 3.3% (adjusted OR, 1.21; 95% CI, 1.04-1.40; P = .01). In this subgroup, the rate of open abdominal surgery increased from 37.2% to 43.0%, and the rate of minimally invasive surgery (total laparoscopic hysterectomy, laparoscopic supracervical hysterectomy, and laparoscopic-assisted vaginal hysterectomy) decreased from 56.1% to 49.7% (P < .001). Major and minor 30-day complication rates among women undergoing hysterectomy for uterine fibroids increased following the FDA-issued statement. This increased risk corresponding with a decreased use of minimally invasive surgery should be balanced against the potential harms of morcellation during a shared decision-making process between clinician and patient. Regulatory bodies and medical societies should consider these findings when issuing relevant communications.

90 - Is There Appropriate Utilization of Alternative Treatment before Hysterectomy for Benign Conditions in Northern California Kaiser Permanente?

Study Objective: To investigate counseling and utilization of alternative treatments before hysterectomy for benign gynecologic indications.

Risk Factors and Outcomes for Conversion to Laparotomy of Laparoscopic Hysterectomy in Benign Gynecology.

To estimate the incidence and factors for conversion to laparotomy in women scheduled for laparoscopic hysterectomy for benign gynecologic indications and to examine the effect of conversion on patient outcomes. A retrospective cohort study of a Michigan multicenter prospective database was abstracted from January 1, 2013, through July 2, 2014. Participants were collected from an all-payer quality and safety database maintained by the Michigan Surgical Quality Collaborative. Women with a preoperative indication of cancer or obstetric indications were excluded. A logistic regression model was used to calculate odds of conversion using patient preoperative and intraoperative attributes. During the study period, 6,992 women underwent an attempted laparoscopic hysterectomy with 3.93% (n=275) converted to laparotomy. After adjusting for socioeconomic differences, hysterectomy indication, and intraoperative factors, there were decreased odds of conversion to laparotomy with use of robotic-assisted laparoscopy compared with traditional laparoscopy (adjusted odds ratio [OR] 0.14, 95% confidence interval [CI] 0.07-0.25) with a predicted risk of conversion of 0.8% compared with 5.4% (P<.001). High-volume surgeons were less likely to convert to laparotomy compared with low- and medium-volume surgeons (adjusted OR 0.66, 95% CI 0.47-0.92) with a predicted risk of conversion of 1.4% compared with 2.25% (P=.015). Conversion was associated with moderate or severe adhesive disease and increasing specimen weight. Conversion was associated with increased rates of surgical site infection, blood transfusion, severe sepsis, and reoperation. This analysis demonstrates that conversion to laparotomy is associated with increased odds of postoperative morbidity, and robotic assistance and surgeon volume are strongly associated with decreased odds of conversion.

Risk of Occult Uterine Sarcoma in Women Undergoing Hysterectomy for Benign Indications.

To estimate the frequency of unsuspected sarcoma identified postoperatively in women undergoing surgery for benign gynecologic indications at our institution. Patients undergoing hysterectomy for benign gynecologic indications from 2000 to 2014 at our institution were identified. Patients who did not have a preoperative suspicion for malignancy and were found to have uterine sarcoma on pathology postoperatively were considered to have an occult uterine sarcoma. Relevant clinical and pathologic data were collected for this retrospective cohort study. A total of 10,119 hysterectomies for benign gynecologic indications were performed between 2000 and 2014. Among these, nine patients were found to have uterine sarcoma, with an overall rate 1 in 1,124 (95% confidence interval 1/592-1/2,457). These malignancies included five leiomyosarcomas, two endometrial stromal sarcomas, and two uterine adenosarcomas. Median age was 39 years (range 25-53 years). Among women found to have occult sarcoma, hysterectomy was performed as a primary indication for abnormal bleeding (77.8%) and leiomyomas (22.2%). Cases included six total abdominal hysterectomies, two total vaginal hysterectomies, and one supracervical hysterectomy. One case required manual morcellation during abdominal hysterectomy. Power morcellation was not used in any of the cases. In summary, occult uterine sarcoma occurs in 0.089% or 1 in 1,124 hysterectomies for benign indications in our population. The frequency is lower than the rate derived in earlier reports and by the U.S. Food and Drug Administration in their pooled analysis.

COMPARISON OF LAPAROSCOPIC AND ABDOMINAL METHODS OF HYSTERECTOMY FROM PATIENT’S PERSPECTIVE

Aims: To compare the postoperative pain and satisfaction of the patients who operated with total laparoscopic and abdominal hysterectomy methods for benign gynecologic conditions. Methods: This study was a prospective randomized trial. Visual Analoque Scala and Patient Satisfaction Score Scalas were used to evaluate patients postoperative satisfaction rate. Seventyone patients who operated by total laparoscopic hysterectomy compared with 68 patients who operated by total abdominal hysterectomy for benign gynecologic indications. Results: The groups were similar in respect to age, race, gravidy and parity status and uterine weight. Hospital stay, need for analgesic use, visual analoque scala pain scores in 12, 24 and 36 hours and patient satisfaction scores in 24,48 hours and 1 st weeks, blood loss were statistically less in laparoscopic hysterectomy group than abdominal hysterectomy group (p<0,001). Conclusion: Laparoscopic hysterectomy was a superior method than abdominal hysterectomy on short term follow-up, patients postoperative pain and satisfaction of the operation scar.

Elective Oophorectomy in the United States

To examine trends in rates of elective bilateral salpingo-oophorectomy in the United States and to assess the association of perioperative complications with elective bilateral salpingo-oophorectomy. This cross-sectional study uses 1998-2006 data from the Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project, a nationally representative sample of inpatient hospitalizations. Analyses were limited to women aged 15 years or older at average risk for ovarian cancer who underwent hysterectomy for a benign gynecologic condition. Tests for trends in elective bilateral salpingo-oophorectomy rates were performed using weighted least squares regression for two time periods, 1998 to 2001 and 2002 to 2006. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for risks of complications associated with elective bilateral salpingo-oophorectomy were estimated using logistic regression. During the period from 1998 to 2006, 39% of the 2,250,041 women who underwent hysterectomy for benign gynecologic indications had elective bilateral salpingo-oophorectomy (rate, 8.3 per 10,000). The elective bilateral salpingo-oophorectomy rate increased from 7.8 per 10,000 in 1998 to 9.0 per 10,000 in 2001 (P trend <.05) and decreased from 9.0 per 10,000 in 2002 to 7.4 per 10,000 in 2006 (P trend <.05). The largest decline from 2002 to 2006 (20.3%) occurred among those aged 45 to 49 years. Compared with hysterectomy only, elective bilateral salpingo-oophorectomy was associated with an increased risk of complications when performed vaginally (OR 1.12; 95% CI 1.08-1.17) and a decreased risk of complications when performed abdominally (OR 0.91; 95% CI 0.89-0.94) or laparoscopically (OR 0.89; 95% CI 0.83-0.94). Elective bilateral salpingo-oophorectomy rates declined since 2002. However, the risks compared with the benefits of the procedure have not been clearly established. Prospective studies examining elective bilateral salpingo-oophorectomy with and without estrogen therapy are needed to guide practice patterns. III.

Sperm interaction with fallopian tube apical membrane enhances sperm motility and delays capacitation

Objective: To understand the effect of sperm contact with the apical plasma membrane of tubal epithelial cells on sperm motility, velocity, and capacitation. Design: Prospective, controlled in vitro study. Setting: University medical center. Patient(s): Women of reproductive age undergoing hysterectomy for benign gynecologic indications and normozoospermic donors of proved fertility. Main Outcome Measure(s): Sperm motility as measured manually, velocity as measured by computer-assisted sperm motility analysis, and capacitation status as measured by the chlortetracycline fluorescence assay. Result(s): Sperm incubated with apical membrane vesicles had a significantly higher motility at 12 (87.4% ± 3.4% versus 69.2% ± 4.8% [mean ± SEMI), 24 (85.2% ± 3.1% versus 60.5% ± 7.2%) and 48 hours (78.9% ± 5.3% versus 42.4% ± 11.3%) compared with control (sperm incubated with human tubal fluid media in the absence of apical membrane vesicles) (n = 4). Progressive velocity was significantly higher at 12 (78.2 ± 1.4 versus 61.7 ± 16.1μm/s) and 24 (66.2 ± 3.9) versus 34.4 ± 9.8μm/s) hours (n = 4). Incubation with apical membrane vesicles significantly slowed the transition from uncapacitated to capacitated chlortetracycline fluorescence pattern (n = 5). Conclusion(s): Contact with the apical plasma membrane of tubal epithelial cells enhances sperm motility and delays sperm capacitation in vitro.

Transabdominal sonohysterography, transvaginal sonography, and hysteroscopy in the evaluation of submucous myomas

To assess the usefulness of transabdominal sonohysterography in the diagnosis and evaluation of submucous myomas. Fifty-two premenopausal women hospitalized for hysterectomy for benign gynecologic indications underwent preoperative conventional transvaginal sonography, transabdominal sonohysterography, and hysteroscopy. The results of the three techniques in terms of diagnosis, size, intracavitary growth, and location of the submucous myomas were compared with those revealed by direct inspection of the surgical specimens. Conventional transvaginal sonography for the diagnosis of submucous myomas had a sensitivity of 90% and a specificity of 98%; the predictive values of abnormal and normal scans were 90 and 98%, respectively. Transabdominal sonohysterography had sensitivity, specificity, and predictive values of 100%, as did hysteroscopy. In all cases, the sonographic techniques measured tumor size more accurately than did hysteroscopy. The transabdominal sonohysterography measurements differed from direct evaluation by no more than 2 mm, and the hysteroscopic measurements were significantly different from those of the surgical specimens. The sonohysterographic evaluation of intrauterine growth was significantly more precise than that of the other techniques, differing from direct measurements by no more than 5-10%. Conventional transvaginal sonography failed to localize three of 11 myomas; hysteroscopy and transabdominal sonohysterography provided the exact location in all cases. Transabdominal sonohysterography is the most accurate technique for detecting submucous myomas and evaluating their size, intracavitary growth, and location.