Endoscopic Removal of Intrauterine Contraceptive Device Perforating Into the Bladder: A Case Report and Review of Literature.

Intrauterine contraceptive device (IUCD) is a commonly used contraceptive method with the advantage of being a long-acting and reversible contraceptive method. However, its insertion can be rarely associated with serious complications such as uterine perforation, which can more rarely result in injury of the nearby viscus. In this report, we document a rare case of IUCD perforation of the uterus and bladder, its diagnosis using transvaginal ultrasonography and hysteroscopy, and management using a minimally invasive approach with a satisfactory patient outcome.

Hysteroscopic management of intramural ectopic pregnancy.

The uterine myometrium is the rarest location for an ectopic pregnancy resulting in the so-called 'intramural or intramyometrial ectopic pregnancy'. It presents a particular diagnostic and therapeutic challenge for the treating physician. If passed undiagnosed can lead to life-threatening uterine rupture, which may warrant hysterectomy, leaving the woman with irreversible infertility. Different treatment modalities have been proposed for the management of this condition. In this case report, we are describing a rare case of intramural ectopic pregnancy and reporting the use of hysteroscopy for the surgical management of this case for the first time in the literature.

A Rare Interlabial Mass in a 9-Month-Old Infant: A Case Report and Review of Literature.

BACKGROUND: Interlabial masses in infants and children are quite rare. One of their rarest causes is urethral polyp or urethral caruncle. It is a benign fleshy outgrowth at the urethral meatus. Certain etiology is still unknown. CASE: A healthy 9-month-old female infant presented with a mass protruding from the vulva with no other complaints. Examination with the patient under general anesthesia revealed an interlabial mass appearing as a pedunculated pinkish polyp, originating from the posterior lip of the external urethral meatus. Surgical excision of the mass was done and histopathology confirmed it to be a urethral polyp. SUMMARY AND CONCLUSION: Urethral polyps are rare in the pediatric age group. Their occurrence in this age group might support a congenital etiology. Surgical resection of polyps allows histopathological examination and a high cure rate with no risk of recurrence.

3D ultrasound assessment of endometrial junctional zone anatomy as a predictor of the outcome of ICSI cycles.

OBJECTIVE: To study the relation between junctional zone thickness (JZ) and success of implantation in IVF/ICSI cycles. STUDY DESIGN: A prospective study included 100 infertility patients undergoing ICSI. The long protocol was used in all patients. JZ was measured using 3D ultrasound, in the coronal section, at three places, on two occasions. First measurement was done before HMG was started (i.e. when down regulation was achieved). Second measurement was done on the day of ovum pick up (OPU). Follow up after treatment was done to determine the rate of implantation. RESULTS: There was a highly significant difference between pregnant and non pregnant treated women regarding the measurement of JZ at the day of OPU at all sites named fundal (0.27±0.1 vs. 0.38±0.14), anterior (0.28±0.07 vs. 0.36±0.09), posterior (0.32±0.1 vs. 0.37±0.09) and average (0.29±0.08 vs. 0.37±0.09) respectively. The cut off value, sensitivity and specificity of measurement of JZ at fundus were (≤0.31,90% and 66.7%), at anterior wall were (≤0.35,90% and 60%), at posterior wall (≤0.25, 50% and 93.3%) and average were (≤0.32,70% and 70%) respectively. CONCLUSION: The thinner the junctional zone at day of OPU, the higher the implantation rate and the difference between JZ measured at the day of down regulation and the day of OPU is a predictor of the outcome of ICSI cycles.

Impact of Uterine Scar on Pain Experienced During Outpatient Hysteroscopy: A Prospective Blinded Comparative Study.

STUDY OBJECTIVE: To study the impact of uterine scar on pain experienced during outpatient hysteroscopy. DESIGN: A prospective blinded comparative study (Canadian Task Force classification II-1). SETTING: Outpatient hysteroscopy clinic at a university hospital. PATIENTS: We included 140 women in the childbearing period attending an outpatient hysteroscopy clinic. Patients were divided into 2 groups. Group A included patients with previous uterine scar (n = 70) and Group B included those with unscarred uterus (n = 70). None of the patients had a previous attempt of a vaginal delivery. INTERVENTION: Diagnostic outpatient hysteroscopy without the use of anesthesia or analgesia. MEASUREMENTS: We assessed pain experienced during and immediately after the procedure using a 100-mm visual analog scale. We also evaluated the successful completion of the procedure. RESULTS: There were no statistically significant differences in the pain scores between patients with scarred uterus and those with unscarred uterus during or immediately after the procedure. The procedure was aborted in only 1 case in the scarred uterus group. This patient had a history of surgical site infection, which may denote a weak scar. There were no statistically significant differences in pain scores between patients with cesarean scar and those with myomectomy scar. No statistically significant differences in pain scores were found between patients with 1, 2, 3, or 4 cesarean deliveries. CONCLUSION: Uncomplicated uterine scars do not have an impact on pain experienced during or immediately after diagnostic outpatient hysteroscopy using a 3.8-mm hysteroscope.