The early benefits of Laparoscopic Sacrocolpopexy.

BACKGROUND: Prospective evaluation of the 6 months functional and clinical outcome of 27 patients treated with Laparoscopic Sacrocolpopexy (LSC). METHODS: Pelvic organ prolapse was assessed by Baden-Walker system along with a validated quality of life questionnaire preoperatively and at 6 months postoperatively to assess vaginal, urinary, bowel and sexual symptoms. RESULTS: At a mean 6 months follow-up, 96% of the symptomatic women had successful vaginal vault support with no recurrence of prolapse symptoms. Successful anatomical outcome (any prolapse ≤ stage 1) was found in 89%. Regarding the urinary functional symptoms, significant improvement was reported in the voiding function, painful symptoms and the relevant quality of life. Stress urinary incontinence resolved in 67% without concomitant continence surgery; 4% from the stress incontinence was de novo. Bowel symptoms were common, both pre- and postoperatively; 40% from the postoperative bowel symptoms was de novo. Sexually active women reported significant improvement in sexual function; there was one case of de novo dyspareunia. CONCLUSION: LSC is an effective treatment for vault prolapse as soon as in the 6-months follow-up. The outcome for anterior and posterior support is less predictable. The pelvic organ vaginal, urinary and sexual functional symptoms improve. The effects on bowel function are less clear. Long-term prospective studies are required to establish the duration of the benefits.

Ovarian Torsion in the Third Trimester of Pregnancy Leading to Iatrogenic Preterm Delivery.

Ovarian torsion in the third trimester of pregnancy leading to a midline laparotomy and caesarean section for the delivery of a preterm baby is an uncommon event. As the woman is likely to present with nonspecific symptoms of lower abdominal pain, nausea, and vomiting, ovarian torsion can often be misdiagnosed as appendicitis or preterm labour. Treatment and the opportunity to preserve the tube and ovary may consequently be delayed. We report the case of a multiparous woman who had undergone two previous caesarean sections at term, presenting at 35 weeks of gestation with a presumptive diagnosis of acute appendicitis. Ultrasonography described a cystic lesion 6 × 3 cm in the right adnexa, potentially a degenerating fibroid or a torted right ovary. MRI of the pelvis was unable to provide further clarity. The patient was managed by midline laparotomy and simultaneous detorsion of the ovarian pedicle and ovarian cystectomy together with caesarean section of a preterm infant. This report describes that prompt recognition and ensuring intraoperative access can achieve a successful maternal and fetal outcome in this rare and difficult scenario. Furthermore, we would like to emphasise that the risk for a pregnant woman and her newborn could be reduced by earlier diagnosis and management of ovarian masses (Krishnan et al., 2011).

Association between chronic pelvic pain symptoms and the presence of endometriosis.

PURPOSE: The link between endometriosis and the presence or intensity of pain is controversial. The aim of the present study was to assess the relationship between chronic pelvic pain (CPP) and severity of endometriosis and the effectiveness of laparoscopic treatment in a 6-month follow-up. METHODS: Prospective observational study in a referral unit. 144 women had laparoscopy to investigate CPP. Symptoms were assessed by a 10-point visual analog scale. The main outcome measure was the frequency and intensity of CPP. RESULTS: No difference in pain was found between women with and without endometriosis. Advanced endometriosis was associated with dysmenorrhea, deep endometriosis with dyspareunia and rectovaginal disease with dyschezia. Laparoscopic treatment improves symptoms. CONCLUSIONS: Women with severe endometriosis are more likely to report severe dysmenorrhoea. Furthermore location of endometriosis in the rectovaginal space is associated with dyschezia and deep endometriosis with dyspareunia. However, the association between presence and stage of endometriosis and severity of symptoms is marginal.

Infertility in polycystic ovary syndrome: focus on low-dose gonadotropin treatment.

Polycystic ovary syndrome accounts for more than 75% of cases of anovulatory infertility. The mechanism of anovulation is uncertain but there is evidence that arrested antral follicle development is associated with the abnormal endocrine profile, in particular the interaction of insulin and LH on granulosa cell differentiation. In terms of management, induction of ovulation can be achieved in most cases by the use of antiestrogens. Treatment of clomiphene-resistant subjects is difficult; conventional doses of gonadotropins are associated with high rates of ovarian hyperstimulation syndrome and multiple pregnancy. On the other hand, low-dose gonadotropin therapy has proven effective in inducing unifollicular ovulation and, in this review, we present, in detail, a recent analysis the results from this center. The cumulative conception rate after six cycles was more than 50% and, importantly, the multiple pregnancy rate was only 3%. Weight reduction in obese subjects with PCOS not only increases the chance of fertility but may also improve the long-term prognosis with regard to development of diabetes. Insulin-sensitizing drugs such as metformin may also have a place in treatment of PCOS.