Pelvic Pressure Research Articles

Replacement of Total Abdominal Hysterectomy by TLH in a Patient with Previous Pelvic Surgery

Background: In a patient who had previous pelvic surgery, total laparoscopic hysterectomy (TLH) has well-established advantages over total abdominal hysterectomy. The hysterectomy is a common gynaecological operation. Although the vaginal route is preferred for hysterectomy, the best route for women who are not candidates for the vaginal approach is unknown. Hysterectomies are increasingly being performed laparoscopically as technology advances and experience grows. Objectives: The aim of this study is to evaluate the replacement of total abdominal hysterectomy by TLH in a patient with previous pelvic surgery. Method: This observational study was carried out on 60 women admitted in the Department of obstetrics and gynaecology, Labaid specialized Hospital, Dhaka, Bangladesh during the study period. The duration of the period was from July 2021 to June 2022. The data for this study about had been accumulated from patients sociodemographic & obstetrics information, physical examination and per-operative findings. Statistical evaluation of the results used to be got via the use of a window-based computer software program devised with Statistical Packages for Social Sciences (SPSS-24). Results: A total of 60 patients were included in final analysis. According to the study population's age distribution of the study population, it was observed that 15(25.0%) were in group 35-38, 23(38.33%) were in group 39-42, 16(26.66%) were in group 43-46 and 6(10.0%) were in group 47-50. according to patient demographics, it was observed that 44(73.33%) were Leiomyoma, 29(48.33%) were Bleeding, 3(5.0%) were Pelvic pressure, 19(31.66) were Pelvic pain and 15(0%) were size growth. Conclusion: TLH for endometrial pathology has few problems and is well tolerated by a restricted group of patients. For suitable patients, the benefits include decreased blood loss and a shorter hospital stay. TLH can be performed effectively despite previous abdominal surgery. Patients who had previous .......

Evaluation of a novel circulation system for ureteroscopic laser lithotripsy in vitro.

To evaluate the cooling effect and other advantages of a novel circulation system for ureteroscopic holmium laser lithotripsy (URSL) in a standardized in vitro model. The novel circulation system was assembled by connecting a 4Fr ureteral catheter and a filter. Trails were divided into a new URSL group and a conventional URSL group. First, different power settings (18-30W) of the holmium laser and irrigation flow rates (20-50mL/min) were used to evaluate the thermal effect on the lithotripsy site of all groups. Then, renal pelvic temperature and pressure were assessed during URSL at a power of 1.5J/20Hz and irrigation flow rates of (20-50mL/min). Finally, the whole process of lithotripsy was performed at 1.5J/20Hz (operator duty cycle ODC: 50%) with an irrigation flow rate of 30mL/min. The time required for lithotripsy, visual field clarity, and stone migration were observed. Temperature of the lithotripsy point was significantly lower in the new URSL group than in the conventional group (P < 0.05) with irrigation rates (20, 30mL/min). The renal pelvic pressure of the new group was significantly lower than that of the conventional group in which intrarenal hypertension developed at an irrigation rate of 50ml/min. The new group had better visual clarity and lesser stone upward migration when lithotripsy was performed at 1.5J/20Hz and 30ml/min. The novel circulation system is more effective in reducing the thermal effects of URSL, pelvic pressure, stone upward migration, and improving the visual clarity of the operative field.

Patient-reported outcome survey of user-experiences in the spinal cord injured-community with MPPT for treating wounds and pressure injuries and for controlling soft tissue infection caused by osteomyelitis.

People with spinal cord injury (SCI) are at high risk of developing pressure injuries. Reports in the SCI-community had indicated that a new class of wound treatment, MPPT (micropore-particle-technology), was effective in treating pressure injuries. The British Spinal Injuries Association therefore conducted a survey among MPPT-users to learn from their experiences. Online survey restricted to individuals with spinal cord injury. Participants were requested to identify themselves to permit validation of statement. The survey had 41 respondents reporting on a total of 49 wounds of which the two main categories were wounds (n = 33), primarily pelvic pressure ulcers; and draining fistulas (n = 9) caused by osteomyelitis. All wounds reported had reached full closure. Median duration of MPPT use and time to closure were 3 and 4 weeks for acute wounds (<6 weeks old) and 8 and 10 weeks for chronic wounds, respectively. On draining fistulas, MPPT had been used to reduce wound size, remove soft tissue infection, avoid sepsis, reduce autonomic dysreflexia, improve overall health, and avoid bed rest, whilst waiting for surgery. Comments on MPPT were 84% highly positive, 11% positive, and 0% negative. No adverse events were reported. MPPT achieved a 100% closure rate of acute and chronic wounds, and, in draining fistulas, effectively controlled soft tissue infection resulting from osteomyelitis. MPPT does not require bed rest and is suitable for self-care and telemedicine, promoting independence and higher quality-of-life. The findings strongly agree with a recent clinical study of MPPT.

Ön Vajinal Duvar Prolapsusunu Taklit Eden Subüretral Abse: Olgu Sunumu

Introduction: Anterior vaginal wall prolapse (AVWP), previously known as cystocele, is a herniation of the anterior vaginal wall and the bladder. It is a multifactorial pathology. Patients with AVWP may report a feeling of pelvic pressure and something bulging out of the vagina, urinary incontinence, and dyspareunia which are nonspecific symptoms. Case: A 73-year-old married Turkish G4P4 female who has been menopausal for 20 years, presented to the outpatient clinic with dysuria and urinary incontinence lasting for two weeks, and a palpable mass located in the genital area for 2 years. On her vaginal examination, the vagina and cervix appeared normal, and a grade 3 AVWP along with a semi-mobile mass extending from the distal urethra to the bladder base under the cystocele pouch was observed. She was diagnosed with a grade 3 AVWP with a plan for the surgical excision. A bilobular cystic mass was observed under the urethra, extending to the bladder wall with a size of 4-5 cm. The macroscopic examination showed a membraneous tissue piece of 4.5 x 2.8 x 2 cm, and the microscopic examination revealed a caseified granulomatous inflammation. Upon the suspicion of tuberculosis, we referred her to the infectious diseases (ID) clinic. Her PPD test was 0 mm. She had no complaints of active tuberculosis. She presented to our clinic with urinary incontinence. On her vaginal examination, involuntary leakage of urine with bladder stimulation was observed. We planned the implantation of transvaginal tape (TVT). Discussion: We believe that this case will help establish an idea about the differential diagnosis of AVWP. The differential diagnosis should include the other possible genitourinary pathologies due to the close proximity of the anterior vaginal wall to the bladder and the urethra before ensuring the diagnosis of the AVWP in order not to misdiagnose.

Analysis of the Efficacy of Elastography in Comparison with Dynamic Renal Nuclear Scintigraphy in the Evaluation of Unilateral Pelvi–Ureteric Junction Obstruction

IntroductionIn hydronephrosis due to pelviureteric junction obstruction (PUJO), an obstruction to urine flow may lead to increased pelvic pressure, which may cause interstitial fibrosis and renal impairment. Recently, there have been reports on renal pelvic assessment using ultrasound elastography (USE). This study was conducted to see if USE can evaluate PUJO and if it can be correlated to the findings of the dynamic renal nuclear scan. Material and methodsIn this observational study, only patients with unilateral PUJO underwent acoustic radiation force impulse (ARFI) elastography. A rectangular region of interest (ROI) measuring 5 × 10 mm was positioned on the cortex region of the upper, mid, and lower poles of the affected kidney. Three valid measurements were obtained, from which a mean value was calculated. A dynamic renal nuclear scan using Technetium-99m ethylene dicysteine (EC or TC99 m EC) was obtained and split renal function (SRF) was used for comparison. ResultsIn the group of 20 patients, the mean age was 3.37 years. The mean SRF of the affected kidney was 26.65 %, and the corresponding USE value was 0.45 kpa. The Spearman's rho correlation coefficient for SRF and USE was 1 and 0.672, respectively (p = 0.001). Elastography was not feasible if SRF was less than 20 %. ConclusionUSE may be able to comment on the renal functional status of hydronephrosis. If USE is reported as non-feasible, it may suggest that renal function is grossly compromised. It may serve as an alternative diagnostic modality for renal functional evaluation. Level of evidenceLevel II, Prospective Cohort Study.

Long-term Health-Related Quality of Life and Symptom Severity Following Hysterectomy, Myomectomy, or Uterine Artery Embolization for the Treatment of Symptomatic Uterine Fibroids

(Abstracted from Am J Obstet Gynecol 2023;229(3):275.e1–275.e17) Symptomatic uterine fibroids (UFs) are benign tumors diagnosed in approximately 30% of American women by the age of 50 years. Symptomatic UFs can significantly affect quality of life (QoL) and have a wide range of symptoms and severity, including pelvic pressure, dyspareunia, sexual dysfunction, infertility, and abnormal uterine bleeding.

Summary of the 2023 report of the international consultation on incontinence interstitial cystitis/bladder pain syndrome (IC/BPS) committee

Interstitial cystitis and bladder pain syndrome are essentially interchangeable as there is no accepted definition that clearly delineates the interstitial cystitis syndrome from bladder pain syndrome. IC/BPS is generally agreed to be defined as chronic pelvic pain, pressure, or discomfort perceived to be related to the urinary bladder when accompanied by at least one other urinary symptom such as persistent urge to void or urinary frequency when in the absence of confusable diseases. The Consultation believes that patients who meet the definition and have a Hunner lesion should be considered to have a distinct confusable disease (Hunner lesion disease — HLD) and be managed accordingly. It follows that early cystoscopy is essential in establishing whether the diagnosis is HLD or IC/BPS. As no single treatment works well over time for a majority of patients, the treatment approach should be tailored to the specific symptoms of each patient and a multidisciplinary approach may be required. A reasonable diagnostic and treatment algorithm is offered by the Consultation. For methodology and the complete report of the committee with complete references, please refer to the 7th edition of the International Consultation on Urological Diseases Incontinence.

Endovascular coil-embolization of an unruptured, true UAA during early pregnancy- a case report

BackgroundTrue uterine artery aneurysms, especially during pregnancy, are a rare entity and not well understood. Clinical symptoms are unspecific pelvic pain and pressure. Diagnosis can be confirmed by transvaginal color-coded-sonography and/or magnetic resonance imaging. Because of potential risk of rupture, immediate interdisciplinary discussion and treatment planning in the best interests of both mother and child is crucial.Case presentationWe present a 31-year-old pregnant woman with increasing pelvic pain and pressure. Diagnosis of an unruptured uterine artery aneurysm was confirmed by color-coded-sonography and magnetic resonance angiography. After interdisciplinary consultation, successful endovascular super-selective coil-embolization was performed by using X-ray fluoroscopy. Thus, fetal radiation dose during treatment with 4.33 mGy (VirtualDoseTM) was as low as possible with no immediate harm to the fetus.ConclusionsUnruptured true uterine artery aneurysms can be successfully treated by endovascular super-selective coil-embolization during early pregnancy with no immediate harm to the fetus.

From Challenges to Discovery: A Case Report on Recurrent Molar Pregnancy in a 30-Year-Old Woman with Multiple Pregnancy Losses

This case report presents the unique case of a 30-year-old woman with a recurrent molar pregnancy, a condition characterized by abnormal growth of placental trophoblasts. The patient, with a gravidity of 3 and parity of 0+2, experienced difficulties in conceiving a viable fetus despite ovulation induction drug treatment. Molar pregnancy is rare, and cases with recurrent miscarriages are even more uncommon. Common symptoms of molar pregnancy include vaginal bleeding, abdominal pain, and pelvic pressure during the first trimester. Diagnosis typically involves assessing HCG serum levels, performing an ultrasound of the uterus, and conducting a biopsy of the aborted specimen. Miscarriage is a common outcome, and in cases of diagnosis, dilation, and curettage are often performed. This report highlights the rarity of recurrent molar pregnancy and emphasizes its potential occurrence.

Pelvic binder radiography detects occult instability in cadaveric simulated lateral compression type I (LC1) pelvic fractures

ObjectivesOccult instability in minimally displaced lateral compression (LC) pelvic ring injuries may have clinical relevance for treatment. We describe two novel LC pelvis fracture stress examinations – pelvic binder stress radiography (PBR) and pelvic binder stress bladder manometry (PBM) – which do not require sedation, anesthesia, patient transport, or radiation of personnel. MethodsA biomechanical study was performed with five fresh elderly cadavers. Sequential osteotomies of the pelvis simulated increasingly unstable LC pelvis fracture patterns (OTA/AO 61A2.2, 61B1.1a, 61B1.1b, 61B2.1). Compressive force was quantitatively applied using a pelvic binder and scale. Pelvis fracture displacement was measured on AP and inlet fluoroscopic views. Pelvic bladder pressure (PBM) was measured using a Foley catheter as a water column. ResultsFracture displacement strongly correlated with force applied (R2=0.600-0.963). PBR discriminated between simulated LC injuries. Mean displacement of 61B1.1b injuries >1cm was observed at 3.8kg on AP view and 5kg on inlet view. Mean displacement of 61B1.1a injuries >1cm was observed at 8.2kg on AP view and 9.3kg on inlet view. 61A2.2 injuries did not displace >1cm at forces up to 10kg. >95% of 61B1.1a and 61B1.1b injuries displaced >1cm at 10kg. PBM moderately correlated with force applied (R2=0.517-0.842) but did not discriminate between LC injuries. ConclusionsPBR is feasible, precisely quantified occult mechanical instability in simulated LC pelvis fractures in response to reproducible applied force, and discriminated between simulated LC pelvis fractures. PBM did not discriminate between simulated LC fractures. A clinical trial to validate the safety and efficacy of PBR for assessing occult instability in LC pelvis fracture is warranted.

Video 9 - Intraoperative Renal Pelvic Pressure Dynamics during Retrograde Surgery

Video 9 - Intraoperative Renal Pelvic Pressure Dynamics during Retrograde Surgery

Pelvic Ectopic Kidney Prevalence and Pressure Changes During Cloacal Exstrophy (Omphalocele-Exstrophy-Imperforate Anus-Spinal Defects Syndrome) Closure

To assess the prevalence of pelvic ectopic kidneys (PEK) and compare renal parameters of the PEK to the orthotopic kidney following pubic bone approximation. In four Omphalocele-Exstrophy-Imperforate Anus-Spinal Defects Syndrome (OEIS) patients undergoing second-stage repair with known pelvic and orthotopic kidneys, changes in the renal pelvis pressure (RPP), peak systolic velocity (PSV), and resistive index (RI) were measured in the pelvic and orthotopic kidneys following pubic bone approximation. A paired t-test was performed for analysis. Prevalence was tabulated using a multi-institutional retrospective review. Mean rise in RPP was +26.0 mmHg in the PEK and +10.3 mmHg in the orthotopic kidney (P = .55). One patient had immediate increase in RPP of 66mmHg in the PEK (7mmHg in the orthotopic kidney) which decreased to +17 mmHg in the PEK upon release of the pubic approximation stitch. Mean change in PSV was +67.7 cm/s in the PEK compared to - 25.7 cm/s in the orthotopic kidney (P = .09). Mean change in renal RI was +0.06 in PEK compared to -0.01 in the orthotopic kidney (P = .29). Among 80 OEIS patients, 24 (30%) had a PEK. 3 (4%) had a solitary PEK. During second-stage OEIS closure, we witnessed patterns of higher change in RPP, PSV, and RI of the PEK compared to the orthotopic kidney. Furthermore, PEKs were found in nearly a third of our OEIS patients. Real-time RPP monitoring, especially those with solitary PEK, may aid in the management of OEIS patients during the perioperative period.

Updates on the Surgical Approach to Fibroids: The Importance of Radiofrequency Ablation.

Uterine fibroids are the most common benign neoplasm of the female pelvis and have a lifetime prevalence exceeding 80% among African American women and approaching 70% among Caucasian women. Approximately 50% of women with fibroids experience symptoms which can range from heavy menstrual bleeding and bulk-related symptoms such as pelvic pressure with bladder and bowel dysfunction to reproductive dysfunction (e.g., infertility or obstetric complications) and pain. The choice of treatment is primarily guided by the type of symptoms in the individual patient and whether they prefer to retain fertility. While hysterectomy provides definitive resolution of fibroid symptoms and remains the most common treatment option, this procedure is invasive with a long recovery window. Radiofrequency ablation (RFA) is now emerging as a uterine preserving and minimally invasive therapy for symptomatic fibroids. Since its introduction, growing evidence for safety and efficacy of RFA has been generated with low rates of complications. This review will discuss RFA for the management of symptomatic uterine fibroids with a special focus on technical approaches, short- and long-term outcomes including fertility outcomes.

Jet Lavage Irrigation Resolves Stage 4 Pelvic Pressure Injury Undermining.

Patients with stage 4 pelvic pressure injuries that have large, undermined cavities are at high risk for treatment failure and often fall into the category of palliative care. This case series identified five cases where treatment had stalled, and surgical reconstructive options were limited. Jet lavage irrigation in the outpatient setting was assessed as a treatment alternative. From an investigational review board study assessing the use of low-pressure jet lavage irrigation in the outpatient setting for chronic wounds, five patients were identified where the wound dimension increased at least 50% resulting from undermined cavities. All were considered high risk with Charlson Comorbidity Index scores of 5 or greater, and their wound healing had stalled with extended treatments of topicals and medicated dressings. A team of physical therapists irrigated these patients' wounds at the bedside with 3 L of saline 3 to 5 days per week using a special long irrigation tip to reach the depth of the undermined cavity. Digital planimetry was used to assess healing with wound size as the outcome. Reduction of the undermined cavities was seen early within the first 3 weeks. No patient developed wound sepsis, and bacterial contamination was determined by use of autofluorescence digital imaging. Undermining resolution occurred in four patients, and one patient with an improving wound died of COVID-19. This simple method offered clear benefits in each patient, but only one patient survived to complete wound healing. Patient and family satisfaction were high regarding the treatment, which created a painless, odor-free wound.

ASSESSMENT OF FACTORS INCREASING THE RISK OF PRELABOUR RUPTURE OF MEMBRANES AND ITS EFFECT ON FETOMATERNAL OUTCOME

Background: Premature rupture of membranes (PROM) refers to a patient who is beyond 37 weeks gestation and has presented with rupture of membranes (ROM) prior to the onset of labor. Patient with PROM presents with leakage of fluid, vaginal discharge and pelvic pressure, but they are not having contraction. It occurs in 3 percent of pregnancies and is the cause of approximately one third of preterm deliveries. It can lead to significant perinatal morbidity, including respiratory distress syndrome, neonatal sepsis, umbilical cord prolapse, placental abruption, and fetal death. Appropriate evaluation and management are important for improving neonatal outcomes. The risk of intrauterine infection increases with the duration of ROM. Evidence supports the idea that induction of labor, as opposed to expectant management, decreases the risk of chorioamnionitis without increasing the cesarean delivery rate. Methods: - This present observational study was conducted at Obstetrics &amp; Gynecology, Department at Sri Aurobindo Medical College and Post Graduate Institute, Indore and who satisfy the inclusion criteria will be studied from 1st April 2021 to 30th September 2022 (18 months). After were Institutional ethical committee. among the patients diagnosed as premature rupture of membrane with women complain of leaking attending antenatal OPD and antenatal ward. On admission detailed history was taken. General and Systemic examination were done including Per Abdomen, Per Speculum and per vaginum carried out and investigations were done as per protocol. Diagnosis of PROM was confirmed by any of this method. Continuous monitoring of maternal and fetal condition done, antibiotics was given intra/ post natal period. P/ V exam were done when necessary. Investigations done and maternal and fetal outcome were noted. Results: The prevalence of premature rupture of membranes (PROM) was found to be 4.1%, with a corresponding perinatal mortality rate of 0.18 per 1000 deliveries. Approximately 33% of the cases involved pre-term premature rupture of membranes (PROM), while the remaining 67% were term PROM. Among the cases with preterm PROM, 10% of the perinatal deaths occurred. The average age of the female participants was 36.9 years, with a standard deviation of 2.1 years. The median number of children per participant was 1, with a range of 1 to 5 children. A notable correlation was observed between the gestational age at which premature rupture of membranes (PROM) occurred in women and the latency period (p&lt; 0.001). There was a significant association between the gestational age at which premature rupture of membranes (PROM) occurred and foetal birth weight, APGAR score, and Neonatal Intensive Care Unit (NICU) admission (p&lt;0.05). A statistically significant distinction was observed between the implemented intervention and the method of delivery (p=0.009). Conclusion: The incidence of PROM at term was high and conservative/ expectant management was effective. The latency period and fetal outcomes such as birth weight, apgar score and NICU admission were determined by the gestational age at which PROM occurred.

Effect of a Multimodal Supervised Therapeutic Exercise Program on Quality of Life, Pain, and Lumbopelvic Impairments in Women With Endometriosis Unresponsive to Conventional Therapy: A Randomized Controlled Trial

ObjectiveTo evaluate the effectiveness of “Physio-EndEA”, a multimodal nine-week supervised exercise intervention, on quality of life, pain, and lumbopelvic impairments in women with endometriosis unresponsive to conventional therapy. DesignParallel-group randomized controlled trial. Outcomes were measured at baseline, post-intervention, and at 1 year. SettingTwo Public University Hospitals. ParticipantsThis trial included 31 women with endometriosis (N=31) randomly allocated to “Physio-EndEA” group (n=16) or control group (n=15). Four participants dropped out of the study for causes unrelated to the intervention. InterventionsThe “Physio-EndEA” program consisted of a 1-week lumbopelvic stabilization learning phase followed by an 8-week phase of stretching, aerobic, and resistance exercises focused on the lumbopelvic area. It was sequentially instructed and supervised by a trained physiotherapist (with volume and intensity progression) and adapted daily to the potential of each participant. Control group received the usual treatment stipulated by their gynecologist. Main Outcome MeasuresThe primary outcome was quality of life. Secondary outcomes were pain intensity, pressure pain thresholds, pain-related catastrophic thoughts, abdominal and back strength, lumbopelvic stability, and muscle architecture. ResultsAdherence rate was 90.6% and mean (±standard deviation) satisfaction was 9.44±0.73 out of 10. No remarkable health problems were reported during the trial. In comparison with controls, the quality of life was improved post-intervention and at 1 year in the Physio-EndEA group with large effect sizes (d>0.80). This group also evidenced: a reduced intensity of dyspareunia, catastrophic thoughts; an increase in pelvic, lumbar, and distal pressure pain thresholds; increases in abdominal and back strength and lumbopelvic stability; and increased thickness of transversus abdominis (right side) and width of lumbar multifidus (left side). ConclusionA 9-week program of multimodal supervised therapeutic exercise is a feasible and effective intervention to improve QoL in women with endometriosis. This program also offers benefits in terms of pain/sensitization and lumbopelvic impairments.

The long-term trend of uterine fibroid burden in China from 1990 to 2019: A Joinpoint and Age-Period-Cohort study.

Purpose: Uterine fibroids occur in 40%-60% of women and are symptomatic in 30% of the patients by causing abnormal uterine bleeding, pelvic pressure, pain, and infertility. The study aims to evaluate the long-term trend of uterine fibroids mortality and disability-adjusted life years (DALYs) in China and the relative risks of age, period, and birth cohort effects. Methods: The mortality and DALYs of uterine fibroids from 1990 to 2019 were derived from the Global Burden of Disease 2019. The annual percentage change and average annual percent change (AAPC) were assessed using the Joinpoint regression. The effects of age, period, and birth cohort on death and DALYs were analyzed by the Age-Period-Cohort framework. Results: The age-standardized rates were all on the ascending trend, with the greatest increase in the age-standardized mortality rate (AAPC, 1.53; 95% CI, 1.04-2.02). The net drift was found to be 3.51% (95% CI, 2.25%-4.78%) per year for mortality and 0.34% (95% CI, 0.14%-0.53%) per year for DALYs. Significant age, period, and birth cohort effects were found for mortality and DALYs (p < 0.001 for all). The mortality risk increased overall with age, but the DALYs risk increased first and then decreased with age. The period and birth cohort risks for mortality and DALYs showed different trends. Conclusion: These secular time trends and changes of mortality and DALYs reveal the socioeconomic alterations, reform of diagnosis and therapy, and changes in social lifestyles and behaviors. Uterine fibroids are still the most common benign gynecological tumors in women, and more epidemiological investigations and social health prevention and control should be applied.

Oral Gonadotropin-Releasing Hormone Antagonists for the Treatment of Uterine Leiomyomas.

Uterine leiomyomas are common hormone-responsive neoplasms that frequently cause heavy menstrual bleeding, anemia, pelvic pressure, pain, and adverse reproductive outcomes. In this overview, the efficacy and safety of oral gonadotropin-releasing hormone (GnRH) antagonists, co-administered with menopausal replacement-level steroid hormones or used at doses to avoid complete hypothalamic suppression, are reviewed for the management of uterine leiomyomas. Oral GnRH antagonists provide rapid suppression of sex steroids and avoid the initial steroidal flare and resultant temporary worsening of symptoms typically seen with parenteral GnRH agonists. Oral GnRH antagonists are effective in reducing leiomyoma-associated heavy menstrual bleeding, with high rates of amenorrhea and improved anemia and leiomyoma-associated pain, and providing modest reduction in uterine volume when used in combination with menopausal replacement-level steroid hormones. This add-back therapy can reduce hypogonadal side effects, including hot flushes and bone mineral density loss, close to levels seen with placebo therapy. Currently, both elagolix 300 mg twice daily with once-daily estradiol (1 mg) and norethindrone (0.5 mg) and relugolix 40 mg once daily with estradiol (1 mg) and norethindrone (0.5 mg) combination therapy are approved for leiomyoma treatment by the U.S. Food and Drug Administration. Linzagolix is under investigation in the United States but approved at two does with and without steroid hormones in the European Union. The efficacy of these agents appears to be robust over a wide spectrum of clinical presentations, demonstrating that worse disease parameters at baseline do not appear to inhibit efficacy. Across clinical trials, participants largely reflected the population of individuals affected by uterine leiomyomas.

MP05-19 WHAT IRRIGATION PRESSURES ARE SAFE? QUANTITATIVE ANALYSIS OF PYELOVENOUS BACKFLOW AT VARIOUS PRESSURES IN A PORCINE MODEL

You have accessJournal of UrologyCME1 Apr 2023MP05-19 WHAT IRRIGATION PRESSURES ARE SAFE? QUANTITATIVE ANALYSIS OF PYELOVENOUS BACKFLOW AT VARIOUS PRESSURES IN A PORCINE MODEL Anne Hong, Greg Jack, and Damien Bolton Anne HongAnne Hong More articles by this author , Greg JackGreg Jack More articles by this author , and Damien BoltonDamien Bolton More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003216.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Irrigation fluid is required for visualization during ureteroscopy and pyeloscopy. Pressurized irrigation can result in pyelovenous backflow of irrigation into the vascular system providing a mechanism for urosepsis. We aim to quantify the amount of irrigation substrate that is absorbed via pyelovenous backflow at various pressures. METHODS: 6 deceased donor porcine kidneys were flushed with 1 L heparinized saline and preserved on ice using a renal transplant protocol. The renal artery was cannulated with a 10Fr catheter and perfused continuously with 0.9% normal saline solution (pH 6.77) at mean arterial pressure of 90 mmHg to simulate arterial blood flow. A steady state of venous effluent from the renal vein was achieved and collected continuously from the renal vein for the duration of the study. The ureter was cannulated with a 10Fr dual lumen ureteric catheter and the tip placed at the ureteropelvic junction and fixed in place with silk ties around the ureter. A pressure monitor (Comet II Pressure Guidewire®, Boston Scientific Corporation, Massachusetts, United States) was inserted through one lumen and positioned in the renal pelvis for continuous renal pelvis irrigation pressure monitoring. Distilled white vinegar (8% acetic acid, pH 3.32) was infused under pressure through the ureteral access catheter at various renal pelvic pressures (RPPs) to replicate pyeloscopy irrigation. RPP was increased in 15mmHg increments every 3 minutes and the venous effluent was collected at each increment. A control arm was conducted using RPP fixed at 30 mmHg for the duration of the 1 hour study with the venous effluent collected in the same 3 minute intervals. Statistical comparisons were performed using Wilcoxon rank test to compare the 15 mmHg increments. RESULTS: Figure 1 show venous pH following simulated ureteroscopy with 8% acetic acid at increasing RPP. Wilcoxon rank test demonstrated that from 90 mmHg onwards, the changes in pH were statistically significant. CONCLUSIONS: Ureteral irrigation fluids are initially detected in the renal venous effluent in trace amounts when renal pelvis irrigation pressures exceed 60 mmHg, and are statistically significant when RPP exceeds 90 mmHg. Source of Funding: Nil © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e51 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Anne Hong More articles by this author Greg Jack More articles by this author Damien Bolton More articles by this author Expand All Advertisement PDF downloadLoading ...

MP42-08 THE MODIFIED UPPER URINARY TRACT VIDEOURODYNAMICS IN PATIENTS WITH REFRACTORY HYDRONEPHROSIS AFTER URETERAL RECONSTRUCTION

You have accessJournal of UrologyCME1 Apr 2023MP42-08 THE MODIFIED UPPER URINARY TRACT VIDEOURODYNAMICS IN PATIENTS WITH REFRACTORY HYDRONEPHROSIS AFTER URETERAL RECONSTRUCTION Xinfei Li, Zhihua Li, Yuke Chen, Yang Yang, Chen Huang, Hongjian Zhu, Liqun Zhou, and Xuesong Li Xinfei LiXinfei Li More articles by this author , Zhihua LiZhihua Li More articles by this author , Yuke ChenYuke Chen More articles by this author , Yang YangYang Yang More articles by this author , Chen HuangChen Huang More articles by this author , Hongjian ZhuHongjian Zhu More articles by this author , Liqun ZhouLiqun Zhou More articles by this author , and Xuesong LiXuesong Li More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003280.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To validate the modified upper urinary tract videourodynamics in reconstructed ureter with still dilation and hydronephrosis, and to explore the significance in guiding subsequent management. METHODS: From December 2018 to November 2021, a total of 137 patients underwent upper urinary tract video urodynamics at the time of nephrostomy removal 3 months after the reconstruction. The urodynamic result was classified into 3 types. Type 1: the pressure remains stable near the baseline throughout the perfusion process, and the reconstructed ureter is well visualized. Type 2: The renal pelvic pressure increases with perfusion, while urography shows the ureteral peristalsis still exists. At the end of the examination, the pressure difference is lower than 15 cmH2O, and the renal pelvis pressure is lower than 22 cmH2O. Type 3: The renal pelvic pressure and pressure difference increase with perfusion and exceed the normal level. At the same time, ureteral peristalsis is weak or absent (Figure 1). RESULTS: The patients were classified as type I in 124 cases, type II in 7 cases, and type III in 6 cases. All patients in type III received further treatment, including regular DJ stent replacement (2 cases), Allium stent (1 case), ureteroscopic balloon dilation (1 case), ureteroneocystostomy (1 case), and ileal ureter (1 case). Patients in type Ⅱ were instructed to avoid holding urine after the removal of nephrostomy and DJ stents. In 124 patients with type I, there was also 1 case receiving balloon dilatation and 4 cases replacing DJ tube. The sensitivity and specificity of the modified upper urinary tract videourodynamics in predicting the need for further treatment were 54.5% and 100% , and the area under curve was 0.747 (p=0.007) (Figure 2). CONCLUSIONS: The modified upper urinary tract videourodynamics can be used to evaluate the dilated upper urinary tract after reconstruction, and the classification has certain guiding significance for further treatment. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e569 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Xinfei Li More articles by this author Zhihua Li More articles by this author Yuke Chen More articles by this author Yang Yang More articles by this author Chen Huang More articles by this author Hongjian Zhu More articles by this author Liqun Zhou More articles by this author Xuesong Li More articles by this author Expand All Advertisement PDF downloadLoading ...