Previous Pelvic Surgery Research Articles

Sonological Evaluation of Ectopic Pregnancy-an Analysis of 50 Cases

Introduction: Ectopic pregnancy is the implantation of a fertilized egg in a location outside of the uterine cavity, including the fallopian tubes, cervix, ovary, cornual region of the uterus, and the abdominal cavity. Objective: To evaluate the sonological findings of ectopic pregnancy. Materials and Methods: A descriptive study was carried out at ultrasound unit in Lab-Aid diagnostic, Comfort Medical Services and Green View Diagnostic Complex in Sylhet city between January 2012 to January 2014. We included all cases with confirmed diagnosis of ectopic pregnancy, all antenatal mothers who are present in antenatal unit in a selected Hospital and excluded mothers with other associated medical condition. Results: Common clinical pattern were shock, marked pallor ness, abdominal pain, amenorrhea and irregular vaginal bleeding 52%, 66%,62%,54% and 38% respectively. Risk factor of ectopic pregnant in this study, 40% had history of infertility, 06% had Non tuberculous PID, 70% had no risk factor, 04% had tuberculous PID, 14% had previous abdominal pelvic surgery, 18% had previous ectopic and 10% had endometriosis. Conclusion: Common clinical pattern were shock, marked pallor ness, abdominal pain, amenorrhea and irregular vaginal bleeding. History of infertility, Non tuberculous PID, no risk factor, tuberculous PID, previous abdominal pelvic surgery, previous ectopic and endometriosis were risk factor of ectopic pregnant in this study. Medicine Today 2022 Vol.34(1): 75-78

Factors associated with non-visualisation of tubal patency during Hysterosalpingo-Foam-Sonography

ObjectiveInvestigate potential factors associated with non-visualisation of tubal patency during Hysterosalpingo-Foam-Sonography (HyFoSy). Study designThis retrospective study was carried out at the medically assisted procreation centre of the University Hospital Centre in Reunion Island and focuses on HyFoSy performed between 01/01/2018 and 31/12/2020.We aimed to compare HyFoSy with bilateral tubal patency and those with a passage defect. Factors associated with non-visualisation of the contrast medium were investigated using comparison tests and logistic regression. Explanatory variables were patient history and ultrasound characteristics. Results137 eligible HyFoSy were included, of which 70.8% could be established for bilateral tubal patency.The assessment of tubal patency decreased in cases of overweight/obesity (62.5% versus 47.4%), previous pelvic surgery (17.5% versus 10.3%) and deep endometriosis (12.5% versus 5.2%), without significant difference. In the logistic regression model, a trend towards significance was observed for body mass index ≥ 25 kg/m² (OR 2.01 [95% CI 0.93–4.35], p= 0.07). ConclusionHyFoSy as a first-line infertility test should be discussed in certain circumstances, due to risk of non-visualisation of tubal patency. In case of poor echogenicity, it should be performed by a trained ultrasonographer or a hysterosalpingography should be preferred. For tubo-pelvic pathologies, a laparoscopy should be discussed for diagnostic and therapeutic purposes. Disciplinegynaecology, infertility.

Ruptured uterus: Frequency, risk factors and feto-maternal outcome: Current scenario in a low-resource setup.

IntroductionPakistan is among the countries with the highest maternal death rates. Obstetric hemorrhage accounts for 41% of these deaths. Uterine rupture is a grave obstetric emergency with high maternal and neonatal morbidity and mortality. It is important to identify its frequency and associated risk factors to formulate programs for its prevention and management. This study aimed to assess the frequency, associated risk factors, fetomaternal outcomes, and management of women with the ruptured uterus at our hospital.Material and methodsIt was a retrospective study of 206 women to review data collected from cases of uterine rupture managed at the WCTH Bannu, Pakistan from October 2016 to October 2018. A structured proforma was designed and used to extract data from operating theatre registers and the hospital medical records. In our hospital, there is a strong system of maintaining all information of the patients related to demographics, obstetric information, operative notes, and postoperative course during their hospital stay in the patient’s charts. Detailed information on operative procedures is further maintained in the operation theater register and all these registers are checked in the weekly statistical meetings to ensure proper documentation. Data was entered and analyzed in SPSS package version 21 (IBM Corp.; Armonk, NY, USA). Frequency and percentages were calculated for the categorical variables. For inferential statistics, chi-square or Fischer exact tests were used. A p-value of < 0.05 was considered statistically significant.ResultsThe overall incidence of the ruptured uterus was 1.71%. The important etiological factors were grand multiparity 62 (35.2%), obstructed/neglected labour 58 (32.9%), injudicious use of Oxytocin 56 (31.8%) and prostaglandins 26 (14.7%), previous cesarean section 35 (19.8%) and previous pelvic surgery (0.5%). Hysterectomy was done in 80.6% of cases, 34 (19.2%) patients underwent uterine repair and 4.5% had bladder repair. The mortality rate was 21%, mainly due to irreversible shock or disseminated intravascular coagulation. Perinatal mortality was 91.4%. Duration of surgery more than two hours and presentation to the hospital at night time was significantly associated with poor maternal outcome (p = 0.00).ConclusionUterine rupture is a preventable obstetric emergency associated with high fetomaternal morbidity and mortality. The main causes were grand multigravidity, obstructed labour, previous C-sections and injudicious use of oxytocin and prostaglandins. Women with prolonged surgery and admission at night time had a poor maternal outcome.

The Impact of Social Determinants of Health on Female Sexual Function

ABSTRACT Introduction Social Determinants of Health (SDOH) like economic stability, education, neighborhood &amp; environment, and social and community context, may significantly impact overall health and drive health disparities. Objective Our aim was to evaluate the association between female sexual function and SDOH. Methods We conducted a cross-sectional study of women 18 and older presenting to outpatient female pelvic medicine and reconstructive surgery (FPMRS) clinics at Montefiore Medical Center (Bronx, NY) from November 2018 to November 2019. The Female Sexual Function Index (FSFI-6) was administered to screen for female sexual dysfunction (FSD) and The Accountable Health Communities Health-Related Social Needs Screening Tool to evaluate unmet social needs. Ordinal logistic regression models were used to examine the association between FSD (defined as FSFI-6 score 19 or less for FSD and FSFI-6 &amp;gt;20 as no FSD) and each social need item, while adjusting for potential confounders. Results 89 women were included in the analysis, with mean age 55.7 years (SD=13.5) and mean BMI 32 (SD=8.4). 4.5% were White, 38.2% Black, 48.3% Hispanic, and 9% did not identify a race or ethnicity. FSD was associated with women who spoke a language other than English or wanted more schooling/training, whereas women who were searching for employment were less likely to have FSD. However, needing family or community support for completion of their activities of daily living (AOR=4.27, 95% CI:(1.05, 17.38), p = .04) was the only social need statistically significantly associated with FSD after adjusting for age, race, BMI, parity and previous pelvic surgery in ordinal logistic regression analysis. Conclusions Family or community support is a social need that was associated with FSD in our diverse, urban cohort. Further exploration with patient interviews may reveal social and cultural beliefs that explain this association. Urologists should consider screening for SDOH to better serve patients with FSD. Disclosure No

23 Corneal ectopic pregnancy attended at a maternity hospital in the Western Amazon: Case report

Introduction: Corneal pregnancy represents about 1% of ectopic pregnancies. Risk factors include pelvic inflammatory disease, previous pelvic surgery, uterine abnormalities and the use of assisted reproduction techniques. In most cases, the diagnosis can be made by blood BhCG levels and transvaginal ultrasound. Laparoscopy has become the gold standard treatment for corneal pregnancies in recent years and has replaced laparotomic procedures. Objectives: to report a case of corneal pregnancy attended at a maternity hospital in the Western Amazon.

Septic arthritis and osteomyelitis of the pubic symphysis – a retrospective study of 26 patients

Introduction: Septic arthritis and osteomyelitis of the pubic symphysis (SAS) are rare conditions with nonspecific symptoms leading to diagnostic delay and treatment. Aim: We draw awareness to this condition elucidating the diagnostic procedures, surgical intervention and antibiotic management. Methods: This entail a retrospective follow-up study of 26 consecutive patients, median age of 71 years (range: 48–89) surgically treated for septic arthritis of the pubic symphysis between 2009 and 2020. Patient files, diagnostic imaging and bacterial cultures were evaluated. Results: Before diagnosed with SAS, 21 of the patients had previous pelvic surgery (16 due to malign conditions, 5 due to benign conditions), while 5 of the patients were not previously operated. Median follow-up period after SAS surgery was 18.5 months (range: 8 to 144.5 months). Dominating symptoms were severe suprapubic/pubic pain ( 26), gait difficulties ( 10) and intermittent fever ( 9). Diagnostic delay was between 1 and 12 months. The diagnostic imaging included magnetic resonance imaging (MRI) ( 24), computer tomography (CT) ( 17) and/or PET-CT ( 10), predominantly displaying bone destruction/erosion of the symphysis ( 13), abscess ( 12) and/or fistula ( 5) in the adjacent muscles. All patients underwent surgical debridement with resection of the symphysis and received a minimum of 6 weeks antibiotic treatment. Fourteen patients presented with monocultures and 4 patients with polycultures. Five patients underwent at least one revision surgery. Twenty-three patients experienced postoperative pain relief at 6 weeks follow-up, and 19 patients were ambulant without walking aids. Conclusion: SAS are rare conditions and should be suspected in patients with infection, pubic pain and impaired gait, especially after pelvic surgery. Bone infection, abscess and fistula near the symphysis can be visualized with proper imaging, most frequently with MRI. For most patients in this cohort surgical debridement combined with a minimum of 6 weeks antibiotic treatment resulted in pain relief, improved walking ability and a low recurrence rate.

Complications associated with the use of prophylactic ureteral stents in gynecologic surgery

To evaluate the rate of complications with use of prophylactic ureteral stents in gynecologic surgery. To compare the occurrence of complications according to the indication of surgery 1,248 women who underwent 1,275 different gynecologic surgeries with use of prophylactic ureteral stents at our institution between September 2007 and December 2020 were included in this retrospective study. Data was collected regarding patient characteristics (age, sex, race, ethnicity, parity, previous pelvic surgery, creatinine), operative characteristics (fellow or resident, guidewire, indication) and complications (ureteral injury, urinary tract complication, restenting, hydronephrosis, urinary tract infection, pyelonephritis, emergency room visit, re-admission) Median age was 57.7 years (Range: 18.4 – 96.5 years), most women (88.9%) were Caucasian, and the majority (77.7%) had previous pelvic surgery. A trainee was involved in 511 (40.1%) surgeries, a guidewire was used in 164 (13.8%), and indication of surgery was benign for 459 (36.0%), urogynecology (urogyn) for 545 (42.7%), and gynecologic oncology (gyn-onc) for 271 (21.3%). Complications for the overall cohort are summarized in Table 1. A comparison of complications according to indication is shown in Table 2. A multivariable analysis was not possible due to low frequency of complications The use of prophylactic ureteral stents in gynecologic surgery is safe as life threatening or permanently disabling complications, including ureteral injury, restenting, hydronephrosis, and pyelonephritis occurred rarely. Gyn-onc patients appear to be at higher risk of stent related complications when compared to surgeries for urogyn or benign indicationsView Large Image Figure ViewerDownload Hi-res image Download (PPT)

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.

830 A Case of Colo-Colonic Intussusception Secondary to A Large Lipoma in An Adult

Abstract Colonic lipomas are benign tumours, most commonly in the right colon or caecum, usually detected incidentally at colonoscopy and are often asymptomatic not requiring treatment. Lipomas leading to intussusception have previously been described in case reports, but it remains a rare occurrence, no specific incidence data has been documented. We present the case of a patient with a 7cm colonic lipoma that developed an intussusception. This patient suffered non-specific pulling pain along the right and upper abdomen for many years. A distal ascending colonic lipoma was identified, on repeated imaging and colonoscopy and biopsied. It was concluded that the abdominal pain was due to gallstones, diverticulitis and adhesions from previous pelvic surgery. In early December 2020, the patient was reviewed and listed for elective cholecystectomy. Later the same month, the patient was admitted with severe abdominal pain, watery and bloody diarrhoea. CT scan showed the colonic lipoma had acted as the lead point for an intussusception, with the lipoma and surrounding colon having intussuscepted into the transverse colon. Patient had an open right hemicolectomy and anastomosis for colo-colic intussusception secondary to the lipoma. Subsequently, the patient developed anastomotic breakdown requiring relook laparotomy with resection of ileo-colic anastomosis and end ileostomy formation. Adults presenting with intussusception is rare and associated with nonspecific signs and symptoms. Variability in clinical presentation highlights the need for a low index of suspicion in people with known colonic masses. In addition, early surgical intervention should be considered in masses &amp;gt;4cm as previously suggested in the literature.

The Influence of Cesarean Delivery on Ovarian Reserve: a Prospective Cohort Study.

To assess the association between cesarean delivery and ovarian reserve, as compared to vaginal delivery. A prospective case control study conducted at a single tertiary medical center between June 2018 and June 2019. Study population included womenwith singleton pregnancy that underwent first cesarean delivery that were compared to women undergoing normal vaginal delivery. Women with low ovarian reserve, endometriosis, previous pelvic surgery, chronic maternal disease, and active labor were excluded. Ovarian reserve was estimated by Anti-Mullerian hormone (AMH) levels that was determined twice for each participant: up to a week before and 3months after delivery. Primary outcome was defined as the delta in AMH levels. Data were analyzed by non-parametric tests. During the study period, 135 women were enrolled, of them 63 (47%) underwent cesarean delivery and 72 (53%) had vaginal delivery. Women in the cesarean delivery group were older (34 (31-38) vs. 32 (29-35); p = 0.001); nevertheless, AMH levels measured before delivery were comparable between the two groups (0.92 (0.51-1.79) vs. 0.95 (0.51-1.79) pg/mL; p = 0.42). AMH levels measured after delivery were more than doubled in the study and control groups (2.15 (1.24-3.05) vs. 2.62 (1.05-5.09); p = 0.50), and delta AMH levels were also found comparable (1.25 (0.61-2.22) vs. 1.59 (0.63-3.41), respectively; p = 0.43). Linear regression analysis including age, mode of delivery, gestational age at delivery, and delta hemoglobin levels revealed that only maternal age was significantly associated with delta in AMH levels (B = - 0.09, p = 0.04). Cesarean delivery does not decrease ovarian reserve as estimated by AMH.

Single-Incision versus Multiport Robotic Myomectomy: A Propensity Score Matched Analysis of Surgical Outcomes and Surgical Tips.

We aimed to compare the perioperative outcomes of single-incision robotic myomectomy (SIRM) and multiport robotic myomectomy (MPRM) and provide surgical tips. We retrospectively analyzed the medical records of 462 patients with symptomatic leiomyoma who underwent MPRM or SIRM between March 2019 and April 2021. Demographic characteristics and surgical outcomes, including the total operative time (OT), estimated blood loss (EBL), and surgical complication rate, were compared between the two groups. Patients in the SIRM group had lower a body mass index and rate of previous pelvic surgery and were younger than those in the MPRM group. The myoma type was not different between groups; however, the MPRM group had larger, and more myomas than the SIRM group. After propensity score matching, these variables were not significantly different between the groups. The total OT, EBL, difference in hemoglobin levels, transfusion rate, and postoperative fever were not different between the groups. No postoperative complications occurred in the SIRM group. In the MPRM group, one patient needed conversion to laparotomy, and two patients had postoperative complications (umbilical incisional hernia and acute kidney injury). In conclusion, both MPRM and SIRM are feasible and effective surgical options for symptomatic myomas with cosmetic benefits and minimal risk of laparotomy conversion.

Narrow Vagina as a Predictor of Obstructive Voiding Dysfunction after Transobturator Sling Surgery

Background: Voiding dysfunction (VD) is a potential complication after female midurethral sling operations. Objectives: Our goal was to assess the rate of obstructive VD after ­transobturator tension-free tape (TOT) procedures and to find perioperative risk factors (RFs) predicting postoperative voiding problems. Methods: We have retrospectively evaluated the perioperative data of 397 women who underwent TOT operations. Significant post-void residual (PVR) (>50 mL) was considered as the primary (objective) end point of the study, the voiding difficulty as the secondary (subjective) 1. First univariate analysis and then multivariate logistic regression were performed, with a 5% significance level. Results: Significant PVR was present in 51 (12.8%) women; catheterization was needed in 21 (5.3%) and reoperation in 3 (0.8%) cases. Seventy women (17.6%) experienced postoperative voiding difficulty. Narrow vagina (<2 cm), older age >70 years, and preoperative voiding difficulty were independent RFs for significant PVR (odds ratio: 5.07, 2.14, 5.38, respectively, p < 0.05). Preoperative overactive bladder syndrome and previous pelvic organ prolapse surgery were considered independent RFs for postoperative voiding difficulty. Conclusions: Older age, narrow vagina, or preoperative voiding difficulty increases the chance for significant postoperative PVR. These patients should be chosen and counseled appropriately.

Inflammatory bowel disease is an independent risk factor for male erectile dysfunction

Background and objective: Inflammatory bowel diseases (IBD) are chronic diseases involving the gastrointestinal system, including ulcerative colitis (UC) and Crohn's disease (CD). Studies have shown a relationship between inflammatory bowel diseases and sexual dysfunction in men but it has been reported that this is due to surgery or the patient's psychological state. In our study, we aimed to assess the impact of IBD on the sexual functioning of male patients who has no previous pelvic surgery by evaluating the depression status of the patients. Materials and methods: The 334 patients who were followed up in our gastroenterology outpatient clinic between January 2021 and March 2021 were included in the study and they were divided into 2 groups as with (n = 146) and without IBD (n = 188). None of the patients had a history of pelvic surgery or pelvic radiotherapy due to IBD or any other disease. The two groups were compared in terms of demographic data, comorbidities, sexual function, depression status and blood tests. International Index of Erectile Function (IIEF) was used in the evaluation of sexual functions, and the Beck Depression Inventory (BDI) was used in the evaluation of depression. Risk factors for erectile dysfunction (ED) were determined. Results: The mean Beck depression test scores of the two groups were found to be similar (p = 0.361). ED was detected in 52.7% of patients with IBD and 32.4% of patients without IBD (p &lt; 0.0001). In multivariate regression analysis, age (p = 0.008), smoking (p &lt; 0.001), presence of diabetes mellitus (p = 0.02) and presence of IBD (p &lt; 0.001) were determined as independent risk factors for ED. Conclusion: Inflammatory bowel diseases can cause ED regardless of the pelvic surgery performed and the psychological status that occur in these patients.

Fallo del mapeo linfático gammagráfico en el cáncer endometrial. Causas y soluciones

AimTo evaluate the effect of technical problems and patient characteristics on sentinel lymph node (SLN) scintigraphic detection and mapping success in early stages of endometrial cancer (EC). MethodsPatients with clinical early stage EC (IA-IB) underwent SLN mapping using technetium-99m-nanocolloid,between September 2011 and February 2020. were included. There were excluded cases with technical problems, 92 patients were included for the analysis of the diagnostic performance and the relation of mapping failure (pelvic unilateral or not detected SLN) with patient (age, body mass index, previous pelvic disease or surgery) and disease characteristics (histology, grade, myometrial invasion, lymphovascular space infiltration, tumor size, and lymphatic infiltration risk). ResultsThe overall detection rate was 79%. Lymph node metastases were diagnosed in 7 patients. Age (p=0.01), depth of myometrial invasion ≥ 50% (p=0.04) and high risk of lymphatic infiltration (p=0.02) were positively associated with mapping failure. In multivariate analysis, age was significantly associated with mapping failure [odds ratio=1.63, 95%CI: 1.06-2.50; p=0.027]. ConclusionsAge, depth of myometrial invasion and high risk of lymphatic infiltration were the factors associated with higher mapping failure. An individualized injection technique, optimizing the methodology, could minimize the detection failures.

Risk factors, clinical presentation and management of ectopic pregnancy in a rural tertiary care centre- An observational study

: Ectopic pregnancy is a challenging and life-threatening emergency, which can cause significant maternal morbidity and mortality. The present study aims at determining the risk factors, clinical features at presentation, diagnostic tools, management modalities and outcome of ectopic pregnancies in a tertiary care teaching hospital.: This was an observational study of 90 cases of ectopic pregnancies admitted to the Department of Obstetrics and Gynaecology at a tertiary care teaching hospital from February 2019 to August 2020. Relevant data of the 90 patients was tabulated and descriptive analysis was done. : Chi square and Fischer exact test: Majority of the patients belonged to 21-30 yrs age group. Maximum number of cases (57%) had a history of previous abdomino pelvic surgery. The predominant symptom was amenorrhea (96.6%) and classical triad of amenorrhea, bleeding per vagina and abdominal pain was seen in 30% of the study population. Majority of the patients i.e 76.7% underwent surgical intervention.: Most common age group at presentation is 21-30years. History of previous abdominal surgery being the most important risk factor whereas amenorrhea was the most common symptom. Surgical intervention was the main mode of management in ruptured ectopic pregnancy.

ROLE OF DIAGNOSTIC HYSTEROSCOPY IN INFERTILE WOMEN WITH NORMAL HYSTEROSALPINGOGRAM

Background: The indication for routine hysteroscopy (HSC) in patients undergoing diagnostic hysteroscopy as part of an infertility work up is still a matter of controversy. Although most clinics continue to use hysterosalpingography (HSG) as their routine test to assess the uterine cavity, there is a growing body of literature dealing with the use of HSC as an important instrument to use in the evaluation and treatment of infertile couples. Objective: To evaluate the role of the diagnostic hysteroscopy in infertile women with normal HSG. Patients and Methods: This cohort observational study was carried out at Ahmed Maher Teaching Hospital, Egypt, from November 2019 till May 2020, on one hundred women Patients having primary infertility. Results: The mean age of the studied cases was 29.58 ± 6.75 with range (20-40). The mean period of infertility was 4.89 ± 1.07 with range (3-7), the mean BMI was 28.27 ± 2.13 with range (25-32). There were 10% illiterate, 45% with moderate education and 45% with high education, there were 92% Primigravida and 8% multigravida, and there were 92% with primary type of infertility, and 8% with secondary type of infertility. There were 17% with diabetes, 28% with hypertension and 13% with previous pelvic surgery. Among the studied cases, there were 38 with detected abnormality, i.e. (5%) endometrial polyp, (2%) Cervical Polyp, (6%) cervical stenosis, (3%) chronic endometritis, (3%) hypertrophic endometrium, (2%) atrophic endometrium, (5%) Intrauterine adhesions, (4%) Cornual fibrosis, (2%) cornual inflammation, (4%) Sub mucous myoma and (2%) septum. There was no significant difference between the cases who detected abnormality and who didn’t as regard age, period of infertility, BMI, education, parity and type of infertility. There was no significant difference between the cases who detected abnormality and who didn’t as regard menstrual history. There was no significant difference between the cases who detected abnormality and who didn’t as regard diabetes, hypertension and previous pelvic surgery. Conclusion: The incidence of uterine pathologies (congenital and acquired) in women with primary or secondary infertility approximated 30%, thus, justifying, the use of diagnostic hysteroscopy in the primary routine investigation of infertile women.

Analysis of perioperative complications and influencing factors of complications in 1 000 cases of robotic gynecological surgery

Objective: To investigate the occurrence and influencing factors of perioperative complications after robotic gynecologic surgery. Methods: The clinical data and occurrence of perioperative complications in 1 000 cases robotic surgery completed in the First Affiliated Hospital of Zhengzhou University were retrospectively analyzed. Results: (1) Clinical data: the average age of the patients was (50.2±10.4) years old, and the average body mass index (BMI) was (24.4±3.6) kg/m2. Among 1 000 cases, 811 cases of them were malignant tumors, including 405 cases of cervical cancer, 279 cases of endometrial carcinoma, 112 cases of epithelial ovarian cancer (EOC), 15 cases of vulvar cancer; 189 cases of them were benign diseases, including 43 cases of uterine prolapse, 57 cases hysterectomy of uterine leiomyoma and adenomyosis of the uterus ≥12 weeks, 84 cases myomectomy of uterine leiomyoma, and 5 cases of fallopian tubal ligation requiring anastomosis. Surgical methods: in patients with malignant tumors, cervical cancer, hysterectomy plus salpingectomy or salpingo-oophorectomy for stage Ⅰa1, and radical hysterectomy plus pelvic lymphatic dissection plus salpingectomy or salpingo-oophorectomy for stage Ⅰa2-Ⅱb. Endometrial carcinoma, performed by staging surgery. Staging surgery for EOC with early stage and cytoreductive surgery with advanced EOC. Vulvar cancer, extensive vulvar resection plus inguinal lymphadenectomy. In patients with benign diseases, uterine prolapse, hysterectomy plus salpingectomy or salpingo-oophorectomy plus sacrocolpopexy. Uterine leiomyoma or adenomyosis with uterus ≥ 12 weeks, hysterectomy plus salpingectomy or salpingo-oophorectomy. Myomectomy for patients requiring uterine preservation with uterine leiomyoma. Tubal anastomosis for patients with fallopian tubal ligation. (2) Surgical complications: intraoperative complications occurred in 25 patients (2.5%, 25/1 000), including 11 patients with vascular laceration, 11 patients with ureteral injury, 2 patients with bladder injury, and 1 patient with intestinal injury. Postoperative complications occurred in 130 patients (13.0%, 130/1 000), including 66 cases of lower limb venous thrombosis, 20 cases of lymphatic cyst, 8 cases of hydronephrosis, 9 cases of ileus, 16 cases with infection, 6 cases with genital fistula, 4 cases with trocar site herniation and 1 case with subcutaneous emphysema. The incidence of intraoperative complications was 3.1% (25/811) in malignant tumors and no case in benign diseases, the incidence rate in malignant tumors was significantly higher than that in benign diseases (χ²=4.778, P=0.029). The incidence rate in cervical cancer (4.2%, 17/405) and EOC (3.6%, 4/112) were significantly higher than those in endometrial carcinoma (1.4%, 4/279) and vulvar cancer (0/15; P<0.05). The incidence of postoperative complications was 15.2% (123/811) in malignant tumors and 3.7% (7/189) in benign diseases. The incidence rate in malignant tumors was significantly higher than that in benign diseases (χ²=17.807, P<0.01), but there were no significant difference among different malignant tumors (χ²=4.318, P=0.229). (3) The correlative factors affecting the occurrence of surgical complications: patient's age, BMI, previous pelvic or abdominal surgery history, the nature of disease (malignant or benign), operation time, and comorbidities had a significant impact on the incidence of postoperative complications (P<0.05). Multivariate logistic regression analysis showed that the patient's age ≥40 years old, BMI ≥25 kg/m2, previous pelvic or abdominal surgery history, malignant tumors and comorbidities were independent influential factors of the postoperative complications (P<0.05). Conclusions: Perioperative complications vary according to the type of the surgery. The age, BMI, previous pelvic or abdominal surgery history, malignant tumors, and comorbidities are influential factors of postoperative complications.

Sexual Dysfunction Among Women With Breast Cancer in the Northeastern Part of West Malaysia.

IntroductionFemale sexual dysfunction (FSD) is a common complication among breast cancer patients following treatment.AimTo assess the prevalence and factors associated with FSD among breast cancer patients in Kelantan.MethodsThis cross-sectional study recruited female patients, aged 18–65, who were married and sexually active with their partner, diagnosed with breast cancer, and had undergone breast surgery. Those with underlying psychiatry disorders, previous pelvic surgery, and husbands with sexual problems were excluded. The questionnaire contained demographic and clinical information, together with the Malay Version of the Breast Impact of Treatment Scale and the Malay Version of Female Sexual Distress Scale-Revised. Their sexual function was evaluated using the Malay Version of the Female Sexual Function Index-6. The data were analyzed with simple and multiple linear regressions.Main Outcome MeasuresThe prevalence and associated factors for FSD in breast cancer patients.ResultsNinety-four eligible patients were recruited for this study. In total, 73.4% (n = 69) of the patients reported having sexual dysfunction. A family history of breast cancer (P = 0.040), duration of marriage (P = 0.046), and frequency of sexual intercourse (P = 0.002) were significant factors associated with FSD in breast cancer patients after surgery.ConclusionThe significant associated factors shown to influence the FSD score include family history of breast cancer, duration of marriage, and frequency of sexual intercourse. About 73.4% of patients have risk of developing FSD after receiving breast cancer treatment.Siang OP, Draman N, Muhamad R, et al. Sexual Dysfunction Among Women With Breast Cancer in the Northeastern Part of West Malaysia. Sex Med 2021;9:100351.

Risk factors for the development of endometrial fluid in women undergoing IVF: A retrospective cohort study✰

Research questionPresence of endometrial fluid (EF) is a poorly understood pathology and remains a challenge for clinicians, as very little data exists to explain its consequences and treatment. Our objective was to investigate risk factors for EF during IVF. DesignThis retrospective cohort study included all women with a freeze all embryos cycle (FAE) for EF between 2010 and 2016 at a university-affiliated private IVF center. Controls (2:1) were randomly selected out of the database of our fresh autologous IVF cycles during the same period. Main outcome measures were possible risk factors for EF, comprising polycystic ovarian syndrome (PCOS), ovarian hyperstimulation syndrome (OHSS), previous pelvic or endometrial surgery (polypectomy or synechia removal), cesarean section, myomas and severe endometriosis. A logistic regression model was used to assess independent risk factors for EF. ResultsOut of 9000 IVF cycles, 1204 were FAE cycles, among which we identified 86 EF cases. We then selected 171 controls. Independent risk factors for presence of EF were a history of previous myomectomy (adjusted odds ratio (aOR) 19.77, 95%CI [4.01–97.53]), severe endometriosis (aOR 5.97, 95%CI [2.09–17.05]), PCOS (aOR 5.72, 95%CI [2.66–12.33]) and previous cesarean section (aOR 5.17, 95%CI [1.84–14.49]). ConclusionsOur results are not only confirming the association between PCOS, severe endometriosis, previous cesarean procedure and EF, but also reporting for the first time an association between previous myomectomy and EF.

Correlation between symptoms and imaging findings including pelvic floor ultrasound to improve the symptom-based diagnosis of female urethral diverticulum (CHECK-UD study).

The objective was to establish a model to predict the presence of a female urethral diverticulum (UD) based on symptoms. A prospective CHECK-UD study (check of female urethral diverticulum) was conducted. Female patients presenting with symptoms such as lower urinary tract symptoms (LUTS), postmicturition dribble or urinary incontinence (UI), dyspareunia or pain in the pelvic area, and recurrent urinary tract infection (UTI) treated between 2015 and 2020 were included. The association between each symptom variable and the positive finding of UD was evaluated by multivariate logistic regression adjusting for age, body mass index (BMI), vaginal deliveries, previous surgery for SUI, previous pelvic surgery, and microscopic hematuria. A predictive model for the presence of UD was then created. In total, 189 female patients with a minimum of one symptom were enrolled. Pelvic floor ultrasound revealed the presence of UD in 66 out of 189 (34.92%). Of the four symptoms, the combinations "LUTS + postmicturition dribble + UTI," "postmicturition dribble + LUTS," and "UTI + LUTS" were most significantly related to positive findings and had a higher positive prognostic value for the diagnosis of UD than each individual symptom alone (OR = 13.78 [95% CI: 6.95-16.35], p < 0.001; OR = 9.94 [95% CI: 4.60-12.2], p < 0.05; and OR = 5.78 [95% CI: 1.58-6.98] p =0.05) respectively. Based on our model, the combination "LUTS + postmicturition dribble + UTI" seems to be the most sensitive combination of clinical symptoms predicting the positive finding of UD. This model could be used for patient counseling and for the identification of patients with UD.