Predictive value of preoperative MRI using the #ENZIAN classification score in patients with deep infiltrating endometriosis.

PURPOSE: The aim of this study is to investigate the correlation between the magnetic resonance imaging (MRI) and intraoperative findings of deep infiltrating endometriosis using the #ENZIAN score. METHODS: This retrospective study included 64 patients who underwent surgery for deep infiltrating endometriosis between January 2017 and August 2020. Preoperative abdominopelvic MRI assessment was evaluated and scored using the #ENZIAN classification. Operative scores were considered the gold standard, and the sensitivity, specificity, and positive and negative predictive values (PPV and NPV) of MRI for each category were calculated. RESULTS: MRI has higher sensitivity and specificity in showing the lesions of the compartments O (ovarian lesions), A (rectovaginal septum and posterior vaginal fornix), and B (uterosacral ligaments and parametrium) (100-100%, 100-100%, and 97-100%, respectively, p < 0.001) compared to the other compartments. The lowest sensitivity, specificity, accuracy, and PPV of the MRI was found in compartment P (14%, 76%, 70%, and 7%, respectively). CONCLUSION: We demonstrated that the #ENZIAN classification in MRI reports has significant sensitivity and specificity in compartments A, B (uterosacral ligaments and parametrium), and O. Furthermore, the determination of peritoneal lesions via MRI is inadequate.

Assessment of the retinal and choroidal microvascularization in polycystic ovary syndrome: an optical coherence tomography angiography study.

PURPOSE: To examine the retinal, peripapillary, choroidal microvascularization and the choroid thickness (CT) of the patients with polycystic ovary syndrome (PCOS) using optical coherence tomography angiography (OCT-A) and compare the results to measurements obtained from healthy controls. METHODS: In total, 47 eyes of 47 patients recently diagnosed with PCOS and 47 eyes of 47 age-matched healthy women were included in this study. An RT XR Avanti instrument with AngioVue software was used for the OCT-A imaging using 6 × 6 mm macular and 4.5 × 4.5 mm optic nerve head scans. Quantitative vessel density results of superficial capillary plexus (SCP), deep capillary plexus (DCP) and radial peripapillary capillaries (RPC); flow area and flow density of choriocapillaris; and foveal avascular zone (FAZ) area were analyzed. CT was evaluated by using the measurements obtained from the subfoveolar area. RESULTS: No significant differences were detected between the groups for any of vessel density results for the SCP, DCP, and RPC as well as the FAZ area. The difference in the choriocapillaris flow area and flow density between the groups was not statistically significant. The choroid was significantly thicker in women with PCOS than in the healthy group (p = 0.002). CONCLUSION: Retinal and choroidal microvascularization was comparable between the women who were evaluated early after diagnosed with PCOS and age-matched healthy controls. Choroid was found thicker in patients with PCOS than in healthy women. OCT-A, as a new and noninvasive imaging method, may help in understanding the effect of PCOS on the posterior segment of the eye.

Vaginal-assisted Laparoscopic Sacrohysteropexy and Vaginal Hysterectomy with Vaginal Vault Suspension for Advanced Uterine Prolapse: 12-month Preliminary Results of a Randomized Controlled Study.

OBJECTIVE: Vaginal-assisted laparoscopic sacrohysteropexy (VALH) is a new modified form of uterine-sparing prolapse surgery using a combined vaginal and laparoscopic approach. We aimed to compare 1 year efficacy and safety of VALH and vaginal hysterectomy with vaginal vault suspension (VH + VVS) in the surgical treatment of apical pelvic organ prolapse (POP). MATERIALS AND METHODS: Women who requested surgical treatment for stage 2-4 symptomatic uterine prolapse were recommended to participate in one year-long randomized study between July 2017 and January 2019. POP Quantification (POP-Q) examination and validated questionnaires such as International Consultation on Incontinence Questionnaire Vaginal Symptoms (IVIQ-VS) survey, Urogenital Distress Inventory (UDI-6), Incontinence Impact Questionnaire Short Form (IIQ-7), and Patient Global Impression of Improvement (PGI-I) were recorded at baseline and 12 months after surgery. The main primary outcome measure was apical prolapse recurrence. Secondary results were duration of surgery, pain score, blood loss, postoperative hospital stay, and quality of life scores related to prolapse. RESULTS: There were 15 women in VALH and 19 women in the VH + VVS group. ICIQ-VS score, ICIQ-QOL, UDI-6, and IIQ-7 scores were improved for both groups. According to the PGI-I scores, 80% of subjects in the VALH group, and 100% in the VH + VVS group, were "very much better" or "much better" with their prolapse symptoms at their 1-year follow-up. There was no reoperation or operation-related complication in both groups. CONCLUSION: VALH and VH + VVS have similar 1-year cure rates and patient satisfaction.

A spontaneous heterotopic pregnancy presenting with acute abdomen treated with natural orifice transluminal endoscopic surgery procedure: Case report.

Heterotopic pregnancy occurs 1 in 30000 pregnancies. We present case of an acute abdomen caused by a ruptured ectopic component. Our patient had no known risk factors, which made the diagnosis even more challenging. Intrauterine pregnancy was desired by patient and her husband. A natural orifice transluminal endoscopic surgery (NOTES) procedure was performed, which is a next-generation minimally invasive procedure in this area. After the procedure, our patient was discharged one day after surgery with a viable intrauterine pregnancy.