A rare case of Asherman's syndrome after open myomectomy: sonographic investigations and possible underlying mechanisms.

AIMS: To present a study on severe Asherman's syndrome after open myomectomy and investigate the possible reasons for this outcome. METHODS: This study involves a rare case of a 38-year-old nulliparous woman who underwent a relatively minor and straightforward open myomectomy in a university hospital setting, during which the uterine cavity was not entered and there were no post-operative complications. Post-operatively the patient had oligomenorrhoea for over a year. The patient was investigated with three-dimensional power Doppler angiography of the uterus and underwent diagnostic/operative hysteroscopy. Main outcome measures were to sonographically assess the blood flow and vascularisation throughout the uterus and to hysteroscopically confirm diagnosis of Asherman's syndrome and treat the patient at the same time. RESULTS: Sonographically there was reduced perfusion in the outer part of the uterus and the scarred areas of the endometrium. Upon hysteroscopic confirmation of diagnosis, the division of adhesions led to a normal sized uterine cavity. CONCLUSIONS: Among the predisposing and causal factors that have been implicated in post-operative adhesion formation, endometrial trauma, infection and tissue hypoxia are considered the most important. This case supports a role for tissue hypoxia in the development of Asherman's syndrome after open myomectomy.

An audit of using the H Pipelle for endometrial sampling at outpatient hysteroscopy and literature review comparison with the Pipelle de Cornier.

OBJECTIVE: To analyse the efficiency of the H Pipelle endometrial sampler at "no touch" (vaginoscopic) diagnostic hysteroscopy in terms of biopsy adequacy for histological diagnosis. STUDY DESIGN: Retrospective descriptive study of 200 premenopausal women including comparison with previously published data on traditional biopsy instruments. RESULTS: Biopsy was adequate in 82% of cases overall, rising to 87% in those without submucous fibroids or polyps. Comparison with published data on other biopsy instruments shows that the H Pipelle is at least as efficient. CONCLUSION: The H Pipelle appears to be at least as effective as traditional endometrial samplers even after hysteroscopy but allows hysteroscopy and biopsy to be done using a purely "no touch" (vaginoscopic) technique.

The "Ruston Stretch": a simple way to get a large specimen out through a small hole.

The balance between port-site size and ease of specimen removal is often a challenge in laparoscopic surgery. Herein we describe a simple technique that circumvents this dilemma by means of port-site dilation using Hegar dilators.

Are there any UPP changes in women with stress urinary incontinence after pelvic floor muscle exercises?

AIM: This study examined the effect of pelvic floor muscle exercises after 12 months of successful treatment for stress urinary incontinence based on subjective (incontinence episodes and pad test) and objective outcome variables (urethral closure pressure, UCP, functional profile length and pressure transmission ratio, PTR). METHODS: Fifty women aged 24-58 years old with genuine stress urine incontinence who successfully underwent pelvic floor muscle exercises, as measured by incontinence episodes and pad test, were included in the study. All women underwent a comprehensive standardized evaluation of urethral pressure profilometry at baseline assessment and at the end of 12 months of pelvic floor exercise program. Maximal UCP, mean UCP, functional profile length or PTR were recorded in all patients. RESULTS: At baseline, the study population had a mean maximal UCP of 33 +/- 20 cm H(2)O, a mean UCP of 18 +/- 10 cm H(2)O, a mean functional urethral length of 22 +/- 5 mm and a mean PTR of 81 +/- 12%. At the end of 12 months of successful and continuous pelvic floor exercises and a significant improvement of incontinence episodes, no difference could be recorded concerning urethroprofilometry parameters studied apart from mean PTR, which was significantly increased. CONCLUSIONS: The results of this study indicate that apart from the mean PTR no other urodynamic parameter reflected the continence improvement of pelvic floor exercise program.

A rare case of bladder fibroepithelial polyp in childhood.

OBJECTIVE: To present a rare case of a benign polyp in a child. Very few cases of urinary tract fibroepithelial polyps in the bladder are reported in the international literature and they are even less common in children. MATERIAL AND METHODS: A 14-year-old boy presented at the Urology Department of "Elpis" Hospital complaining of painless macroscopic hematuria during the last six months. The patient did not report previous urinary tract disorders. After a thorough laboratory investigation, which included urinalysis, urine culture, ultrasonography, intravenous pyelography and cystoscopy the presence of an exophytic papillary tumor in the bladder was identified. The lesion was removed transurethrally. RESULTS: The biopsy set the diagnosis of fibroepithelial polyp, which is a rare benign neoplasm and occurs in patients of nearly all ages. Polyps are located usually in the ureteropelvic junction, the upper third of the ureter and the posterior urethra. They are rarely found in the bladder, especially in the childhood.