Spontaneous Expulsion Research Articles

Efficacy of Conservative Therapy versus Tamsulosin Added Therapy in Patients with Lower Ureteral Calculi and their Health Related Quality of Life

Background: Alpha-1 blockers reduce smooth muscle tension and alleviate spasms, thereby decreasing obstructions and relieving irritative symptoms in the lower urinary tract. This study aimed to assess the effectiveness of Tamsulosin and its impact on health-related quality of life in patients with distal ureteral calculi. Methods: A total of 120 patients with distal ureteral calculi were enrolled in this study and randomly assigned into two groups. Group 1 (n=60) received conservative therapy, while Group 2 (n=60) received Tamsulosin (0.4 mg daily) in addition to conservative therapy. All patients were monitored for pain, intensity of ureteric colic, and spontaneous stone expulsion. Health-related quality of life (HRQoL) was assessed for each patient using the RAND SF-36 Health Survey 1.0. Results: Spontaneous stone passage occurred in 52 patients (85%) in Group 1 and in all 60 patients (100%) in Group 2, with a statistically significant difference between the groups (P<0.001). Analysis by stone diameter further indicated significant differences favoring Tamsulosin treatment for stones ≤6 mm (P=0.04) and >6 mm (P=0.003). Health-related quality of life scores were significantly higher in the Tamsulosin group compared to the conservative therapy group. Conclusion: Tamsulosin, an alpha-1 blocker, is recommended for treating distal ureteral calculi, as it facilitates faster stone expulsion, increases expulsion rates, and enhances quality of life by reducing the frequency and severity of ureteric colic.

Laryngotracheal Foreign Body Spontaneously Expelled in Children: An Unusual Observation

Laryngotracheal foreign bodies are a life-threatening emergency. The diagnosis is suspected by the onset of laryngeal dysphonia and confirmed by cervico-thoracic radiography. Suspension laryngoscopy under general anaesthetic enables the foreign body to be located and extracted. However, spontaneous expulsion of a laryngotracheal foreign body, considered an unusual situation, may be observed during coughing fits or vomiting. In this case report, we describe a laryngeal foreign body that was expelled spontaneously on the 11th day of hospitalisation at Brazzaville University Hospital.

PREDICTIVE FACTORS AFFECTING THE SUCCESS OF MEDICAL EXPULSIVE THERAPY IN PATIENTS WITH DISTAL URETERAL STONE

OBJECTIVE: In this study, we aimed to investigate the factors affecting spontaneous stone passing in patients who received medical expulsive therapy due to distal ureteral stones. MATERIAL AND METHODS: From September 2022 to October 2023, a total of 148 patients with distal ureteral stones sized 4-10 mm were included. Patients received silodosin 4 mg as medical expulsive therapy and were followed up for a maximum of four weeks. The patient- and stone-related variables affecting spontaneous stone passage were evaluated. RESULTS: The mean age of the participants was 42.92±12.78 years. The stone expulsion rate was 64.2%. The rate of spontaneous stone passage was significantly higher in patients with lower stone size, stone burden, ureteral wall thickness, distance of the stone to the ureterovesical junction, neutrophil-lymphocyte ratio and hydronephrosis grade. (all, p<0.05). The distance of the stone to the ureterovesical junction, ureteral wall thickness, and neutrophil-to-lymphocyte ratio were independent predictors of spontaneous passage (p:0.036, p:0.001, p:0.001, respectively). CONCLUSIONS: The distance of stone to the ureterovesical junction, ureteral wall thickness, and neutrophil-to-lymphocyte ratio can be useful parameters to estimate spontaneous stone expulsion. These factors play important roles in decision-making for the management of distal ureteral stones.

Comparison by Mode of Delivery of Preterm Pregnancy Inductions with Cervical Ripening Balloon: A Retrospective Chart Review

Background: Preterm inductions may be necessary for maternal comorbidities or fetal abnormalities. Previous studies have identified risk factors for undergoing a cesarean delivery (CD). Our study examined the insertion-to-expulsion time (IET) of cervical ripening balloons (CRB) in preterm inductions that achieved vaginal delivery (VD) compared to CD. Methods: This was a retrospective cohort study of preterm inductions with CRB between 2010 and 2021. Primary outcome was IET of CRB. IRB approval was obtained. Results: The study included 82 women. IET for cesarean patients was significantly greater, and required more removal of CRB at the allotted 12 h. Dilation before and after CRB was significantly greater in the vaginal cohort. There was no significant difference in maternal comorbidities, indication for induction or neonatal complications. Conclusions: Maternal comorbidities, induction indication and neonatal complications were similar between cohorts, making trial of induction with CRB in preterm women a reasonable option. Spontaneous expulsion of CRB and greater dilation may be predictors of vaginal delivery.

Efficacy of sexual stimulation in the treatment of distal ureteral stones: A meta-analysis

IntroductionThis study aimed to compare the clinical efficacy of sexual stimulation with that of placebo in the treatment of distal ureteral stones. MethodsWe searched PubMed, Web of Science, Cochrane Library, and Google Scholar from January 1, 2000 to December 31, 2022 for studies comparing the efficacy of sexual stimulus with that of placebo for the treatment of distal ureteral stones. RevMan 5.3 software was used to pool the data. The study protocol was registered on PROSPERO (Registration Number: CRD42023432408). ResultsA total of six randomized controlled trials comprising 535 cases of distal ureteral stones were included in this study. Among these, 273 cases were associated with sexual intercourse or masturbation 3–4 times a week, while 262 cases only received symptomatic treatment. The pooled results showed that the 2-week [risk ratios (RR) = 1.77, 95 % confidence interval (CI): 1.34, 2.33] and 4-week [RR = 1.48, 95 % CI: 1.29, 1.69] ureteral stone expulsion rates of the sexually stimulated group were significantly higher than those of the placebo group (ps < 0.01). Additionally, sexual stimulation was associated with a shorter ureteral stone expulsion time [weighted mean differences (WMD) = −3.74, 95 % CI: −6.27, −1.22, p < 0.01] and a decreased prevalence of renal colic attacks [WMD = −0.61, 95 % CI: −1.01, −0.22, p < 0.01] compared with those of the placebo group. ConclusionAppropriate sexual stimulation can enhance the spontaneous expulsion of distal ureteral stones in patients presenting with tolerable pain.

Failed prevention of benzodiazepine withdrawal symptoms due to spontaneous expulsion of diazepam suppository administrated via stoma: A case report.

Failed prevention of benzodiazepine withdrawal symptoms due to spontaneous expulsion of diazepam suppository administrated via stoma: A case report.

Evaluation of a urinary filtration device for kidney stone retrieval: Pi-Box®

IntroductionThere is an unmet need to offer a proper urinary straining device for patients in whom spontaneous expulsion of stones is expected. The objective of this study was to assess the efficacity, duration and ease of use of a new filtration device: the Pi-Box®. Material and methodsThis was a single-institution, non-randomized open-label study. Consecutive male patients with at least one stone that was susceptible of spontaneous passage, or after shockwave lithotripsy were included. The first 30 consecutive patients (Group 1) used the usual recommended techniques, and the 30 following consecutive patients (Group 2) were given the Pi-Box®. The patients completed a questionnaire when seen at 1-month follow-up. ResultsSixty men were included between January 2023 and May 2023. Thirteen (43%) patients retrieved a stone in each group (P=1). Filtration was performed for a median of 5 days in Group 1 and 10 days in Group 2 (P=0.03). Fourteen (46%) patients were satisfied or very satisfied with their filtration technique without the device versus 18 (60%) with the Pi-Box® (P=0.3). Eighteen (60%) and 21 patients (70%) would recommend their straining technique to a relative in groups 1 and 2, respectively (P=0.42). ConclusionsThe number of straining days was twice longer with the Pi-Box® device and is in favor of a better observance. The device did not increase the number of stones retrieved by urine filtration, which was high in this pilot study and may have been due to a participation bias. Level of evidence2B

FIRE Stones: impact of forced diuresis on the residual fragment rate after flexible ureteroscopy for destruction of kidney stones with laser—protocol for a randomized controlled two-parallel group multicenter trial with blinding evaluation

BackgroundLithiasis is a common and recurrent disease. Flexible ureteroscopy (fURS) is the cornerstone of laser treatment of kidney stones. Kidney stones destruction requires its laser pulverization into small fragments in order to remove them through the ureter or improve their spontaneous expulsion along the urinary tract. However, most of the time, all the micro-fragments and dust created cannot be extracted using our surgical tools and may stay intra-renally at the end of the procedure. Adjuvant treatments (such as forced diuresis, inversion or mechanical pressure) were previously described to improve the expulsion of stone fragments after extra-corporeal shock wave lithotripsy. Nevertheless, the impact of adjuvant treatment after fURS remains unclear and mainly theoretical.ObjectiveThe primary objective is to show that the injection of 40 mg of furosemide in slow intravenous during 10 min, after the procedure, increases the stone-free rate 3 months after a fURS for destruction of kidney stones with laser.Methods/designThe study will be a two-parallel group randomized, controlled, multicentric trial with a blinding evaluation. Nine French departments of urology will participate. Patients will be randomized in 2 groups: the experimental group (injection of 40 mg of furosemide at the end of the surgery) and a control one (usual care). Patients will be followed up for 3 months (± 2 weeks) after the surgery. Then, we will perform a low dose abdomino-pelvic CT scan. The primary outcome is the stone-free rate at 3 months. A centralized review of the images will be performed by two specialized radiologists, in a blind and crossed way to allow a homogenization of the results. The secondary outcomes will include the rate of early post-operative urinary tract infection (UTI), the evaluation of post-operative pain, and the safety of the use of furosemide in patients treated by fURS for renal stone laser destruction. As secondary objectives, it is also planned to look at the effect of the prescription of an alpha-blocker as usual treatment on stone-free rate and to assess the agreement between the imaging analysis of the urologist and the specialized radiologist.DiscussionLithiasis is a public health problem. It affects about 10% of the general population. This prevalence is increasing (multiplied by 3 in 40 years), partly due to changes in the population’s eating habits over the years. The lithiasis patient is a patient with a chronic disease requiring annual follow-up and who may suffer from multiple recurrences, with a recurrence rate at 5 years of 50%.Recurrences are partly due to residual fragments left in the kidneys at the end of the operation. Other risk factors for recurrence include dietary hygiene and the presence of an associated metabolic disease. The metabolic blood and urine tests recommended by the Association Française d’Urologie (AFU) can be used to manage these last two problems.As far as residual fragments are concerned, their presence leads to an early recurrence of stones because they form the bed for a new aggregation of crystals in the kidneys. Being able to reduce the rate of residual fragments in patients with the use of furosemide at the end of the intervention therefore seems essential in the management of recurrences in our patients. This will also improve our patients’ quality of life.Indeed, lithiasis disease leads to chronic pain associated with acute pain that motivates consultations to the emergency for specialized management. This study is the first to evaluate the impact of forced diuresis with the use of furosemide on the stone-free rate after a fURS for destruction of kidney stone with laser.Trial registrationClinicalTrials.gov Identifier: NCT05916963, first received: 22 June 2023.EU Clinical Trials Register EudraCT Number: 2022-502890-40-00.

Spontaneous expulsion of sub-mucous fibroid within twelve hours of emergency caesarean section: A case- report

Spontaneous expulsion of sub-mucous fibroid within twelve hours of emergency caesarean section: A case- report

Spontaneous heterotopic pregnancy resulting in tubal rupture and complete spontaneous abortion: a case report in Tiko, Cameroon

Introduction and importance: A heterotopic pregnancy (HP) following spontaneous conception is a rare and potentially life-threatening condition. Its diagnosis can be overlooked, hence remaining one of the challenging gyneco-obstetrical emergencies, especially in the low-resource setting. Case presentation: A 24-year-old G2P0010 at 11 weeks of gestation with a history of one induced abortion and a family history of twin pregnancies presented with an acute abdomen, associated with vaginal spotting in an afebrile context. An abdominopelvic ultrasound showed retained products of conception, and the presence of a left adnexal mass suggestive of an extrauterine gestational sac at ~6 weeks of gestation. There was spontaneous expulsion of retained products of conception. The deterioration of the hemodynamic stability of the patient prompted an emergency laparotomy to be done. The patient was transfused, postsalpingectomy counseling done and was discharged on oral analgesics, blood tonics, and antibiotics on day 6 postoperation. Clinical discussion: HP following spontaneous conception is a rare and potentially life-threatening condition. This case reports on the management of spontaneous HP resulting in a ruptured ectopic pregnancy (EP) and a complete spontaneous abortion managed in a low-resource setting. This case emphasizes the importance of a systematic ultrasound to be done for all patients with a clinically confirmed abortion to rule out an associated EP. Conclusion: A spontaneous abortion without signs of peritoneal irritation can be associated with an EP. Ultrasound can help in the early diagnosis, and laparotomy can be life-saving.

Menstrual cup use and intrauterine device expulsion in a copper intrauterine device randomized trial

ObjectiveTo evaluate menstrual cup use and intrauterine device (IUD) expulsion. Study designWe performed a secondary analysis of a 3-year contraceptive efficacy trial comparing two copper 380 mm2 IUDs. Investigators randomized participants approximately 1:4 to the TCu380A or NTCu380-Mini IUD. Approximately 12 months after enrollment began, we advised participants against menstrual cup use due to observed IUD expulsions in cup users. We evaluated IUD expulsion (including spontaneous partial and complete expulsion and accidental self-removal) at 12 and 36 months. We used multivariable logistic regression to evaluate IUD expulsion by age, baseline menstrual volume, body mass index, IUD type, menstrual cup use, parity, and uterine length. ResultsThis analysis included 1046 participants (203 TCu380A and 843 NTCu380-Mini), with 879 (84.0%) nulliparas. Through 12 and 36 months, expulsion occurred in 74 (7.1%, 95% CI 5.5–8.6%) and 133 (12.7%, 95% CI 10.7–14.7%) participants, respectively. Overall, 250 (23.9%) reported menstrual cup use. More menstrual cup users than non-users experienced expulsion through 12 months (32/203 [15.8%] vs. 42/843 [5.0%]) and 36 months (58/250 [23.2%] vs. 75/796 [9.4%]). Through 36 months, NTCu380-Mini menstrual cup users had higher expulsion odds, while TCu380A cup users did not. Menstrual cup users more frequently experienced accidental self-removal than non-users in participants using the TCu380A (3/53 [5.7%] vs. 0/150 [0.0%]) and the NTCu380-Mini (20/197 [10.2%] vs. 7/646 [1.1%]). In multivariable regression, we found increased odds of expulsion through 36 months in participants using menstrual cups with the NTCu380-Mini (aOR 3.13, 95% CI 1.16–8.46) and <25 years (aOR 1.59, 95% CI 1.07–2.34). ConclusionsWe found higher odds of IUD expulsion with menstrual cup and concurrent NTCu380-Mini IUD use over 36 months of use, but not with concurrent TCu380A IUD use. Menstrual cup users experienced higher likelihood of accidental self-removal regardless of IUD type. ImplicationsMenstrual cup and NTCu380-Mini use may increase IUD expulsion risk and may increase accidental self-removal risk with TCu380A and NTCu380-Mini use. Clinicians should advise patients of these risks and consider warning patients using an IUD shaped like the NTCu380-Mini (Nova-T frames) of expulsion risk with menstrual cup use.

Spontaneous anal expulsion of an osteosarcoma in a cat

A 6-year-old spayed female domestic short hair cat was evaluated because of a 1-month history of straining to defecate and partial rectal prolapse, with expulsion of a 1 cm in diameter, white-to-red, firm-to-hard, homogenous nodule from the anus. The nodule was collected by the submitting veterinarian and submitted for histologic examination. Histologic features were consistent with an osteosarcoma. The cat was euthanized, and no autopsy was performed. Although the origin of the osteosarcoma could not be determined, the clinical history was suggestive of a lower gastrointestinal tract osteosarcoma that detached from its primary site and exited through the anus, similar to what is rarely reported for intestinal polyps and lipomas in human medicine. No reports of such event were found in veterinary medicine.

Induction of labor via Foley balloon catheter placement for 6 vs 12 hours in women with 1 previous cesarean delivery and unfavorable cervices: a randomized controlled trial

Induction of labor in women with 1 previous cesarean delivery and unripe cervices is a high-risk process, carrying an increased risk of uterine rupture and the need for cesarean delivery. Balloon ripening is often chosen as prostaglandin use is associated with an appreciable risk of uterine rupture in vaginal birth after cesarean delivery. A shorter duration of placement of the balloon typically expedites delivery; however, this has not been evaluated in induction of labor after 1 previous cesarean delivery. This study aimed to compare Foley balloon catheter placement for 6 vs 12 hours in induction of labor after 1 previous cesarean delivery. A randomized controlled trial was conducted in a university hospital in Malaysia from January 2022 to February 2023. Eligible women with 1 previous cesarean delivery admitted for induction of labor were enrolled. Participants were randomized after balloon catheter insertion for 6 or 12 hours of passive ripening before balloon deflation and removal to check cervical status for amniotomy. The primary outcome was the induction of labor to delivery interval. The secondary outcomes were largely derived from the core outcome set for trials on induction of labor (Core Outcomes in Women's and Newborn Health [CROWN]). The Student t test, Mann-Whitney U test, chi-square test, and Fisher exact test were used as appropriate for the data. Overall, 126 women were randomized, 63 to each intervention. The mean induction of labor to delivery intervals were 23.0 (standard deviation, ±8.9) in the 6-hour arm and 26.6 (standard deviation, ±7.1) in the 12-hour arm (mean difference, -3.5 hours; 95% confidence interval, -6.4 to -0.7; P=.02). The median induction of labor (Foley balloon catheter insertion) to Foley balloon catheter removal intervals were 6.0 hours (interquartile range, 6.0-6.3) in the 6-hour arm and 12.0 hours (interquartile range, 12.0-12.5) in the 12-hour arm (P<.001). The median induction of labor to amniotomy intervals were 14.1 hours (interquartile range, 9.3-21.8) in the 6-hour arm and 19.0 hours (interquartile range, 15.9-22.0) in the 12-hour arm (P=.02). The usage rates of epidural analgesia in labor were 46.0% (29/63) in the 6-hour arm and 65.1% (41/63) in the 12-hour arm (relative risk, 0.71; 95% confidence interval, 0.51-0.98; P=.03). Spontaneous balloon catheter expulsion rates were 22.2% (14/63) in the 6-hour arm and 17.5% (11/63) in the 12-hour arm (relative risk, 1.27; 95% confidence interval, 0.63-2.58; P=.50), and additional ripening use rates (Foley reinsertion) were 46.0% (29/63) in the 6-hour arm and 31.7% (20/63) in the 12-hour arm (relative risk, 1.45; 95% confidence interval, 0.92-2.27; P=.10). The results were not different. Moreover, maternal satisfaction scores (0-10 numerical rating scale) of 9 (range, 8-10) in the 6-hour arm and 9 (range, 8-10) in the 12-hour arm (P=.41) were not different. Other secondary maternal and neonatal outcomes were not significantly different either. Foley balloon catheter placement for 6 hours hastened birth and reduced epidural analgesia use in labor without a change in maternal satisfaction.

EFFICACY AND SAFETY OF INTRA CAESAREAN IUCD

The objective of this study was to evaluate the effectiveness and complications of post-partum intrauterine contraceptive device (PPIUCD) insertion during cesarean delivery. The study was conducted at Nishtar Medical Hospital from June to December 2022. A total of 150 women were included in the study. In the first phase, medical eligibility for the intervention was assessed, while in the second phase, WHO Medical Eligibility Criteria were evaluated. The IUCD was manually inserted after delivery with its string towards the cervix. The patients were followed up at 2 and 6 months. After 6 months, 9 (6%) cases reported abdominal pain, 22 (15%) had menorrhagia, and 23 (15.3%) had missed threads with the IUCD in place. None of the patients reported pregnancy or perforation of the uterus. After 6 months, 133 (88.6%) patients continued to use this method of contraception, while 9(6%) were lost to follow-up, 4 (2.6%) had the device removed due to complications, and 4 (2.6%) had spontaneous expulsion. The study concluded that PPIUCD is a safe and effective long-term contraceptive method. Clinicians should evaluate patients' eligibility for PPIUCD and counsel women on adopting this method.

Prediction of Spontaneous Stone Expulsion by Serum C-Reactive Protein in Patients with Distal Ureteric Calculi

Introduction: Ureter obstruction caused by a ureteral stone triggers inflammatory change in the proximal submucosal layer and prevents passage of the stone which can increase C-reactive protein level. The present study was designed to see if CRP plays a role in predicting the expulsion of distal ureteric calculi of &lt;10 mm in patients presenting to urology department. Methods: A cross-sectional study was done at National Medical College, Department of Surgery, Birgunj from January 2022 to June 2022. Total of 60 cases were included in the study who presented with distal ureteric calculi. Level of CRP was recorded and divided into &lt;6 mg/dl and &gt;6 mg/dl. Size of stone and rate of spontaneous expulsion was noted. Results: Among the 60 cases, 34 (56.7%) were males and 26 (43.3%) were females. Mean age of the study cases was 36.1±11.76 years and mean size of stone 6.72±1.54 mm. among the total cases 28 (47%) had CRP level &lt;6mg/dl and 32 (53%) had CRP level &gt;6mg/dl. Among the total cases 35 (58.3%) did not pass stone spontaneously and the size of stone was 6.9743±1.74598 mm. spontaneous passage of stone was not seen in 21 (60%) male and 14 (40%) female cases. Significant difference (p=&lt;0.001) was seen between expulsion and non-expulsion of stone. Conclusion: Measurement of CRP at the time of presentation with distal ureteric calculi of small size can help the urologist to predict whether spontaneous expulsion is possible or not.

Pediatric Foreign Body Ingestion - Expectations and Outcomes

BACKGROUND&#x0D; Lockdowns, travel restrictions, and homeschooling during the COVID-19 period contributed to an increased number of foreign bodies being swallowed by children. This single-center study was initiated to determine the incidence of foreign body ingestion in the pediatric age group during the 2-year period of COVID-19 and compare it with an earlier 3-year period in Saudi Arabia.&#x0D; METHODS&#x0D; Medical records and abdominal radiographs of children under 14 were reviewed for the history of foreign body ingestion. The frequency of foreign body ingestion, size, shape, type, and outcomes during the COVID-19 pandemic was compared with similar events in the 3 years before the COVID-19 pandemic from November 2016 to November 2019.&#x0D; RESULTS&#x0D; Of the n = 161 records, n = 86 cases were reported during the COVID-19 pandemic, and n = 75 in the pre-pandemic period. Most of the ingested foreign bodies were less than 2 cm in size (57.8%), with the prevalence of non-metallic objects (87.6%) and the outcome being spontaneous expulsion (83.2%). There was a significant association between spontaneous expulsion cases and the size of the objects (p = 0.001), number of objects (p = 0.0005), and shape (p = 0.01). An analysis of demographic data showed that more boys than girls were registered, with a predominance of children under the age of five.&#x0D; CONCLUSIONS&#x0D; Treating children who have swallowed foreign bodies require a multi-professional approach with the participation of physicians, nurses, poison control specialists, radiologic technologists, ambulance personnel, and others to provide continuous, child-friendly care and follow-up. Parents and caregivers should be aware of how to keep children away from small items that can be harmful if swallowed, especially coins, disc batteries, small magnets, and other high-risk items.

1229 Spontaneous Heterotopic Pregnancy Resulting in Tubal Rupture and Complete Spontaneous Abortion: A Case Report in Tiko, Cameroon

Abstract Aim To present a case report of the management and early outcome of a first-trimester spontaneous heterotopic pregnancy (HP) in a low-resource setting. Method This piece of work has been reported according to the Surgical CAse REport guidelines. Results A 24years old G2P0010 at 11 weeks of gestation with a history of one induced abortion and a family history of twin pregnancies presented with an acute abdomen, associated with vaginal spotting in an afebrile context. Recurrence of the vaginal spotting and increase in the severity of the abdominal pain prompted an obstetrical ultrasound which showed retained products of conception, as well as the presence of a left adnexal mass suggestive of an extrauterine gestational sac at approximately 6 weeks of gestation. There was spontaneous expulsion of retained products of conception. The deterioration of the haemodynamic stability of the patient prompted an emergency laparotomy to be done after a repeat ultrasound suggestive of a ruptured left ectopic pregnancy (EP), and optimisation of the patient. Evacuation of 700ml of dark red haemoperitoneum and salpingectomy was done. The patient was transfused, post-salpingectomy counselling done and was discharged on oral analgesics, blood tonics and antibiotics on day 6 Post–operation. Conclusions HP should be suspected in first trimester bleedings especially if associated with an acute abdomen. An ultrasound should be performed on all patients presenting with clinical manifestations of abortion to help in the early diagnosis and treatment of a concurrent EP. Laparotomy is relatively safe in the context of abortion and shock secondary to haemoperitoneum.

Is a fish bone at a parallel angle in the throat more likely to fall out automatically？

To investigate the factors influencing the spontaneous expulsion of fish bone foreign bodies in the throat of children.A retrospective cohort study was conducted between January 2018 and December 2021 of children hospitalized with fishbone foreign bodies in the throat, and subsequent electronic rhinolaryngoscopy to analyze the factors influencing the spontaneous expulsion of these foreign bodies.The effect of foreign body angle on the rate of dislodgement was found to be statistically significant. Parallel angle was more likely to dislodge relative to vertical (RR = 2.495, 95% CI 1.515-4.109, P = 0.000); inclined angle was more likely to dislodge relative to vertical (RR = 2.121, 95% CI 1.284-3.505, P = 0.003). For the three fish bone foreign body angles (vertical, inclined, and parallel), the percentage of dislodgement showed a linear trend (0.278, 0.600, and 0.723), indicating that the percentage of dislodgement appeared to increase with the increase of fish bone foreign body inclination angle (Ptrend = 0.000).There is a high rate of natural expulsion of fish bone foreign body from children's throat, and the rate of expulsion increases with the increase of the foreign body inclination angle.

P-751 Comparing levonorgestrel intrauterine system versus hysteroscopic niche resection in women with postmenstrual spotting related to a niche in the uterine caesarean scar

Abstract Study question To compare the effectiveness of levonorgestrel-releasing intrauterine system (LNG-IUS 52mg) with hysteroscopic niche resection in the reduction of niche-related postmenstrual spotting. Summary answer In women with niche-related postmenstrual spotting, LNG-IUS did not more often reduce spotting days with 50% at 6th month than hysteroscopic niche resection. What is known already Both Levonorgestrel intrauterine system (LNG-IUS) and hysteroscopic niche resection are widely implemented to reduce niche-related postmenstrual spotting. The study aimed to compare the effectiveness of LNG-IUS 52mg with hysteroscopic niche resection in the reduction of niche-related postmenstrual spotting. Study design, size, duration A randomised, open-label, controlled trial conducted at one medical center in Shanghai, China. From September 2019 to January 2022, we randomised 208 women to LNG-IUS (N = 104) or hysteroscopic niche resection (N = 104).The primary outcome was reduction of postmenstrual spotting at 6th month after randomisation, defined as percentage of women with a reduction of at least 50% in spotting days from baseline. Efficacy and safety were assessed by an intention-to-treat analyses. Participants/materials, setting, methods Women with symptoms of postmenstrual spotting after CS, with a niche depth of at least 2 mm and residual myometrium of at least 2.2mm on Magnetic Resonance Imaging (MRI), and no intention to conceive within the next year were randomly assigned to treatment with LNG-IUS 52mg or a hysteroscopic niche resection. Main results and the role of chance At 6th month follow-up, a 50% reduction of spotting had occurred in 78.4% (80/102) women in the LNG-IUS group and 73.1% (76/104) women in the hysteroscopic niche resection group (RR = 1.07, [95%CI 0.92-1.25]; P = 0.370). Spotting reduced over time (Ptrend=0.001), with a stronger reduction in the LNG-IUS group (P = 0.001), while there was also a significant interaction between time and treatment (P = 0.007). From nine months onwards, reduction of spotting occurred significantly more after LNG-IUS than hysteroscopic niche resection (9th month 89.2% vs. 72.1%, RR = 1.24, [95% CI 1.08-1.42]; 12th month 90.2% vs. 70.2%, RR = 1.29, [95% CI 1.12-1.48]). Moreover, compared with the hysteroscopic niche resection group, the LNG-IUS group had significantly fewer postmenstrual spotting days and total bleeding days from six months onwards (all P &amp;lt; 0.001), and less pelvic pain from three months onwards (all P &amp;lt; 0.010). Intervention-related complications were not reported in any of the groups. During follow-up, eleven (10.8%) women reported hormonal related side-effects and two (2.0%) women had spontaneous partial expulsion in the LNG-IUS group, while in the hysteroscopic niche resection group three unintended pregnancies were reported. Limitations, reasons for caution Due to the nature of the intervention, it was not possible to blind participants and gynaecologists for treatment allocation.The cut-off value chosen for our primary outcome and the moment of assessment for our primary endpoint can both be debated. Wider implications of the findings LNG-IUS provides an alternative treatment for women with niche-related gynaecological symptoms and no active desire to become pregnant. Trial registration number Chinese Clinical Research Center (ChiCTR1900025677)

Osseous metaplasia of the uterus: an interesting presenting complaint and case of secondary infertility: case report.

The authors present a case of a woman with the feeling of a foreign body in the vagina and a long-standing history of secondary infertility of unknown cause. She was found to have osseous metaplasia of the uterus with spontaneous expulsion of the bony fragments from the uterus into the cervical canal, creating the sensation of foreign body in the vagina. She was treated with hysteroscopic resection. Fertility returned 3 months post procedure. This case provides a valuable reminder that osseous metaplasia can have a varied clinical presentation and requires a careful history and examination. This case reinforces the importance of a thorough diagnostic assessment in the woman presenting with foreign body in the vagina/cervix and /orsecondary infertility. This rare but important diagnosis can have a lasting impact on a woman's reproductive health if left untreated.