Changes in lower urinary tract function after minimally invasive nerve-sparing for complete excision of endometriosis: An observational study.

OBJECTIVES: The objective of this paper is to evaluate changes in lower urinary tract symptoms (LUTS), severity of pain and urodynamic parameters after minimally invasive nerve-sparing surgery for patients with endometriosis. METHODS: We analyzed 143 patients undergoing minimally invasive nerve-sparing surgery for endometriosis excision (laparoscopy/robot-assisted). The endometriosis was confirmed by preoperative clinical evaluation, magnetic resonance imaging (MRI) showing at least one lesion deeper than 5 mm, and histological confirmation after laparoscopy. We evaluated three points prior and after surgery: LUTS parameters according to the International Urogynecological Association; urodynamic measures of storage and voiding and the severity of the dyspareunia, dyschezia and dysmenorrhea assessed on a self-reported 11-point numeric rating scale. The Wilcoxon signed rank and McNemar tests were used for statistical analyses (p < 0.05). RESULTS: We observed significant improvements in LUTS after the surgery with postoperative symptom-free probabilities in urgency (64.5%), daytime frequency (38.5%), and dysuria (87.1%). However, slow stream prevalence increased significantly postsurgery (p = 0.022), with a 20.5% risk of asymptomatic patients developing this symptom. Urodynamic responses varied; for instance, maximum cystometric capacity improved significantly (p = 0.004), while postvoiding residual worsened (p = 0.006). Significant worsening in postvoiding residual occurred in women with normal preoperative values (p = 0.002), with a 17.7% risk of normal values becoming abnormal. Compliance or maximum cystometric capacity not considered normal preoperatively showed significant improvements (p < 0.001), but the risk of normal values becoming abnormal after surgery was 14.5%. CONCLUSION: The minimally invasive nerve-sparing surgery for endometriosis excision shows improvement in lower urinary tract symptoms, urodynamics parameters and severity of pain. The majority of patients became asymptomatic in the postoperative period. When compared to the benefits of the patients' surgical treatment, particularly when considering the reduction of pain, the risks of the lower urinary tract treatment seem to be acceptable. The surgical intervention seems to be a safe alternative in patients with endometriosis, although studies with larger samples are needed to confirm these findings.

Dynamic cystoscopy to optimize preoperative assessment of bladder endometriosis

ABSTRACT Purpose Bladder endometriosis (BE) accounts for 84% of cases of urinary tract involvement. The use of cystoscopy for preoperative evaluation is limited. The aim of this study was to evaluate the accuracy of preoperative dynamic cystoscopy (DC) in patients undergoing surgery for deep endometriosis and to describe the main findings and their impact on surgical planning. Materials and Methods This cross-sectional observational study was conducted from January 2011 to March 2022. DC findings were divided into two groups according to the depth of involvement. To estimate sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV), laparoscopic findings of bladder involvement and histopathological report were used as the gold standard. Results We included 157 patients in this study. 41 had abnormalities in DC. Of these, 39 had abnormalities that were confirmed intraoperatively. The sensitivity and specificity of the test were 58.21% and 97.78%, respectively. PPV was 95.12%, and NPV was 75.86%. The presence of any lesions in the DC had a diagnostic odds ratio (OR) of 61.28 for BE. Patients with BE type 2 had a higher rate of partial cystectomy than those with BE type 1 lesions (OR 9.72 CI 95% 1.9-49.1) Conclusion DC appears to be a highly specific test with lower sensitivity. DC abnormalities are associated with a higher ratio of bladder surgery for the treatment of deep endometriosis, and BE type 2 seems to be associated with a greater ratio (9.72) of partial cystectomy.

Dynamic cystoscopy to optimize preoperative assessment of bladder endometriosis.

PURPOSE: Bladder endometriosis (BE) accounts for 84% of cases of urinary tract involvement. The use of cystoscopy for preoperative evaluation is limited. The aim of this study was to evaluate the accuracy of preoperative dynamic cystoscopy (DC) in patients undergoing surgery for deep endometriosis and to describe the main findings and their impact on surgical planning. MATERIALS AND METHODS: This cross-sectional observational study was conducted from January 2011 to March 2022. DC findings were divided into two groups according to the depth of involvement. To estimate sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV), laparoscopic findings of bladder involvement and histopathological report were used as the gold standard. RESULTS: We included 157 patients in this study. 41 had abnormalities in DC. Of these, 39 had abnormalities that were confirmed intraoperatively. The sensitivity and specificity of the test were 58.21% and 97.78%, respectively. PPV was 95.12%, and NPV was 75.86%. The presence of any lesions in the DC had a diagnostic odds ratio (OR) of 61.28 for BE. Patients with BE type 2 had a higher rate of partial cystectomy than those with BE type 1 lesions (OR 9.72 CI 95% 1.9-49.1) Conclusion: DC appears to be a highly specific test with lower sensitivity. DC abnormalities are associated with a higher ratio of bladder surgery for the treatment of deep endometriosis, and BE type 2 seems to be associated with a greater ratio (9.72) of partial cystectomy.

Paracolpium Leiomyoma Misdiagnosed as Endometriosis: Case Report and Surgical Technique of a Laparoscopic Approach.

A 36-year-old Caucasian, nulliparous patient sought care at a private gynecology clinic after 6 months of attempting to conceive. During the initial consultation, the patient reported severe dysmenorrhea and deep dyspareunia. During the gynecological examination, a nodule in the left lateral vaginal fornix was palpable. The MRI showed a hypointense nodular lesion in the left paracolpium described as an endometriosis nodule. Laparoscopic resection of the nodule was indicated. The patient showed improvement in symptoms after surgical treatment. This case report describes the technique for laparoscopic approach to paracolpium tumors.

Endometriosis Surgery during the First Wave of the COVID-19 Pandemic: A Brazilian Single Institution Experience.

Introduction. Early in the 2020 Coronavirus pandemic stay-at-home guidelines, there were public health orders that elective surgeries be deferred to prioritize hospital beds for critically ill COVID-19 patients. Besides, several reasons led to the postponement of consultations, diagnostic tests, and elective therapeutic procedures. As a result, some women with endometriosis faced chronification of their pain and decreased prospects for pregnancy. The aim of this study was to describe individual responses to minimally invasive complete excision of endometriosis through 40 days of follow-up of women whose endometriosis was considered severe enough to proceed with surgery during the fourth, fifth, and sixth months of constraints imposed by the pandemic. Preventive strategies and safety measures employed to protect patients and staff from acquiring or transmitting Coronavirus infection are presented. Case Presentation. This case series report enrolled 11 consecutive Brazilian women (ages 22 to 47 y) who underwent minimally invasive surgical treatment of endometriosis between June 26 and August 17, 2020. Cases of endometriosis requiring more urgent surgery were promptly identified and considered individually. The strict safety measures were well accepted by patients. No women developed any flu-like or COVID-19-related symptoms (cough, dyspnea, fever, or anosmia) in the 40 days of postoperative follow-up. One of the most praised measures reported by patients was the routine testing of the patient, the person who would accompany her in the hospital, and all medical staff and employees. Discussion. It is feasible to safely perform elective endometriosis surgery in selected cases during a pandemic.

Lateral Compartment Endometriosis is Associated with Retraction of the Obliterated Umbilical Artery.

BACKGROUND AND OBJECTIVES: Based on laparoscopic views, we hypothesized that the involvement of the lateral compartment of the pelvis (LCP) by deep infiltrating endometriosis can be inferred by observing retraction of the obliterated umbilical artery (OUA) toward the abdominal cavity. We sought to verify the association between the retraction of the OUA and the presence of endometriosis in the ipsilateral LCP (parametrium, paracervix, or paracolpium). METHODS: This preplanned, retrospective, cross-sectional study evaluated 76 women with deep endometriosis at a private referral center. Using magnetic resonance imaging, the retraction of OUA was represented by its distance from the rectus abdominis (four different measurements were used). The diameter of the OUA was also measured and considered. T2-weighted imaging of the pelvis were obtained in two planes (sagittal and axial) and from two reference points: the proximal angle of the artery (measurement 1) and a point immediately above (measurement 2). The measurements were assessed through an exploratory multivariate principal component analysis. The associations were tested using the bivariate, non-parametric statistical Mann-Whitney U test. RESULTS: The presence of endometriosis of all LCP examined was 34.2% (95% confidence interval: 26.8-41.7) with the highest percentage in the paracervix. The retraction of the OUA was greater in women with endometriosis in the ipsilateral LCP for all four measurements and was statistically significant for three of them: Sagittal 1 (p = .011), Sagittal 2 (p = .015), Axial 1 (p = .021), and Axial 2 (p = .093). The OUA diameter was not associated with its retraction (p = .392). CONCLUSION: Retraction of the OUA toward the abdominal cavity is associated with the presence of endometriosis in the ipsilateral paracervix.

Six-month follow-up of minimally invasive nerve-sparing complete excision of endometriosis: What about dyspareunia?

STUDY OBJECTIVE: To assess individual changes of deep dyspareunia (DDyspareunia) six months after laparoscopic nerve-sparing complete excision of endometriosis, with or without robotic assistance. METHODS: This preplanned interdisciplinary observational study with a retrospective analysis of intervention enrolled 126 consecutive women who underwent surgery between January 2018 and September 2019 at a private specialized center. Demographics, medical history and surgery details were recorded systematically. DDyspareunia (primary outcome), dysmenorrhea and acyclic pelvic pain were assessed on self-reported 11-point numeric rating scales both preoperatively and at six-month follow-up. Cases with poor prognosis in relation to dyspareunia were described individually in greater detail. RESULTS: Preoperative DDyspareunia showed weak correlation with dysmenorrhea (rho = .240; P = .014) and pelvic pain (rho = .260; P = .004). Although DDyspareunia improved significantly (P < .001) by 3 points or more in 75.8% (95%CI: 64.7-86.2) and disappeared totally in 59.7% of cases (95%CI:47.8-71.6), individual analysis identified different patterns of response. The probability of a preoperative moderate/severe DDyspareunia worsening more than 2 points was 4.8% (95%CI: 0.0-10.7) and the probability of a woman with no DDyspareunia developing "de novo" moderate or severe DDyspareunia was 7.7% (95%CI: 1.8-15.8) and 5.8% (95%CI: 0.0-13.0), respectively. In a qualitative analysis, several conditions were hypothesized to impact the post-operative DDyspareunia response; these included adenomyosis, mental health disorders, lack of hormone therapy after surgery, colporrhaphy, nodule excision in ENZIAN B compartment (uterosacral ligament/parametrium), the rectovaginal septum or the retrocervical region. CONCLUSION: Endometriosis surgery provides significant improvement in DDyspareunia. However, patients should be alerted about the possibility of unsatisfactory results.

Prognostic factors of death in children during the first year of life due to congenital diaphragmatic hernia: analysis of a hospital cohort from 2005 to 2015 / Fatores prognósticos para o óbito de crianças no primeiro ano de vida por hérnia diafragmática congênita: análise de uma coorte hospitalar de 2005 a 2015

Abstract Objective: To describe and analyze the prognosis of children during the first year of life with a diagnosis of congenital diaphragmatic hernia admitted between the years 2005 and 2015 in the Neonatal Intensive Care Unit. Method: In a retrospective cohort, 129 children with a diagnosis of congenital diaphragmatic hernia were studied. The prognostic factors were analyzed, whereupon prenatal, delivery, and postnatal exposure variables were associated with death during the first year of life. The odds ratio and the confidence interval (95% CI) were calculated for all the studied variables, using the chi-squared test and Student's t-test. Results: The study included 129 children hospitalized from January of 2005 to December of 2015. Seventy-nine (61%) patients died, 50 survived, and 33 had other associated malformations. Among the prognostic factors, the following were significant and increased the chance of death: polyhydramnios (p = 0.001), gestational age of the earliest diagnosis (p = 0.004), associated congenital abnormalities (OR: 3.013, p = 0.022), pO2 of the first gasometry (p = 0.000), pCO2 of the first gasometry (p = 0.000), presence of pulmonary hypoplasia (OR: 3.074, p = 0.000), use of preoperative vasoactive drugs (OR: 2.881, p = 0.000), and use of nitric oxide (OR: 1.739, p = 0.000). The presence of only intestines in the hernia content was a protective factor (OR: 0.615, p = 0.001). Conclusion: The mortality in the first year of life in patients with congenital diaphragmatic hernia in this study was 61% in the years 2005-2015. Among the prognostic factors that demonstrated a significant effect, pulmonary hypoplasia had the greatest impact.

Resumo Objetivo: Descrever e analisar o prognóstico de crianças ao longo do primeiro ano de vida com diagnóstico de hérnia diafragmática congênita admitidas entre 2005 e 2015 na Unidade de Terapia Intensiva Neonatal. Método: Em uma coorte retrospectiva estudamos 129 crianças com diagnóstico de hérnia diafragmática congênita. Foram analisados os fatores prognósticos onde as variáveis de exposição do pré-natal, parto e pós-natais foram associadas ao óbito no primeiro ano de vida. Calculamos a odds ratio (OR) e o intervalo de confiança (IC95%) para todas as variáveis estudadas, sendo utilizados os testes de qui-quadrado e o teste T Student. Resultados: Foram incluídos no estudo 129 crianças, internados de janeiro/2005 a dezembro/2015. Foram a óbito 79 (61%) pacientes, 50 sobreviveram e 33 tinham outras malformações associadas. Entre os fatores prognósticos foram significativos e aumentaram a chance de óbito a polidrâmnia (p = 0,001), idade gestacional do diagnóstico mais precoce (p = 0,004), anomalias congênitas associadas (OR: 3,013, p = 0,022), pO2 da primeira gasometria (p = 0,000), pCO2 da primeira gasometria (p = 0,000), presença de hipoplasia pulmonar (OR: 3,074, p = 0,000), uso de drogas vasoativas pré-operatórias (OR: 2,881, p = 0,000) e o uso de oxido nítrico (OR:1,739, p = 0,000). A presença de apenas intestinos no conteúdo da hérnia foi um fator protetor (OR: 0,615, p = 0,001). Conclusão: A mortalidade no primeiro ano de vida em portadores de hérnia diafragmática congênita, neste estudo, foi de 61% de 2005 a 2015. Entre os fatores prognósticos que demonstraram um efeito significativo, a hipoplasia pulmonar foi o de maior impacto.

Five-Month Follow-Up Assessing Defecography and Urodynamics after Laparoscopic Nerve-Sparing Colorectal Resection for Endometriosis.

INTRODUCTION: Large resections may be necessary in cytoreductive surgery for endometriosis, which present risk of urinary and bowel complications. Presentation of Case. A 29-year-old woman underwent multidisciplinary laparoscopy for endometriosis in a private practice setting for acyclic pelvic pain and cyclic abdominal distension with changes in bowel habits and frequent sensation of incomplete defecation. After surgery, urodynamics remained normal and bowel function improved subjectively and objectively per dynamic magnetic resonance defecography (DMRD). The five-month follow-up found improvements in pain scores, bowel function, and health-related quality of life (assessed by the full versions of the Short Form 36 and Endometriosis Health Profile 30 scales). Discussion. Animus may contribute to the bowel symptoms in women with endometriosis. DMRD provides additional objective parameters for comparing pre- and postoperative functions. CONCLUSION: A nerve-sparing segmental rectosigmoidectomy for endometriosis carefully executed by a multidisciplinary team can preserve the function of different pelvic organs.

Practical considerations in the use of a porcine model (Sus scrofa domesticus) to assess prevention of postoperative peritubal adhesions.

Infertility has been a common postoperative problem caused by peritoneal adhesions. Since several prophylactic agents have recently shown promising preliminary results, more complete studies comparing their real efficacy and safety are needed urgently. The aim of this study was to investigate and describe practical considerations of a porcine model that can be used to assess such prophylactic agents. First, 10 healthy 5½ months old female pigs (24.3-31.3 Kg) underwent a standardized laparoscopy to provoke peritubal adhesion formation without prophylactic agents. After 30 days, a second-look laparoscopy was performed to evaluate adhesions and perform adnexectomy for histopathological evaluation. Adhesions at different sites were classified by grade, for which the scores range from 0 (no adhesion) to 3 (very strong vascularized adhesions), and also by area, with scores ranging from 0 (no adhesion) to 4 (>75% of the injured area). The histopathological evaluation of the distal uterine horns, oviducts and ovaries were compared withthose from a control group of six healthy pigs with no previous surgery. Biological samples were collected to assess vitality, inflammation and renal, hepatic and hematopoietic systems. There were small (but significant) changes in serum albumin (P = 0.07), globulin (P = 0.07), C-reactive protein (P = 0.011), fibrinogen (P = 0.023) and bilirubin (P<0.01) after 30 days, but all values were within the normal range. No inflammation or abscess formation was observed, but different degrees of adhesion were identified. The estimated occurrence of adhesion (scores >0) and of strong / very strong adhesion (scores >1) was 75% (95% CI: 55-94.9) and 65% (95% CI: 45-85), respectively. The porcine model represents a useful animal platform that can be used to test the efficacy and safety of candidate prophylactic agents intended to prevent postoperative peritubal adhesions formation. We present several practical considerations and measures that can help to minimize animal suffering and avoid problems during such experiments.

Prognostic factors of death in children during the first year of life due to congenital diaphragmatic hernia: analysis of a hospital cohort from 2005 to 2015.

OBJECTIVE: To describe and analyze the prognosis of children during the first year of life with a diagnosis of congenital diaphragmatic hernia admitted between the years 2005 and 2015 in the Neonatal Intensive Care Unit. METHOD: In a retrospective cohort, 129 children with a diagnosis of congenital diaphragmatic hernia were studied. The prognostic factors were analyzed, whereupon prenatal, delivery, and postnatal exposure variables were associated with death during the first year of life. The odds ratio and the confidence interval (95% CI) were calculated for all the studied variables, using the chi-squared test and Student's t-test. RESULTS: The study included 129 children hospitalized from January of 2005 to December of 2015. Seventy-nine (61%) patients died, 50 survived, and 33 had other associated malformations. Among the prognostic factors, the following were significant and increased the chance of death: polyhydramnios (p=0.001), gestational age of the earliest diagnosis (p=0.004), associated congenital abnormalities (OR: 3.013, p=0.022), pO2 of the first gasometry (p=0.000), pCO2 of the first gasometry (p=0.000), presence of pulmonary hypoplasia (OR: 3.074, p=0.000), use of preoperative vasoactive drugs (OR: 2.881, p=0.000), and use of nitric oxide (OR: 1.739, p=0.000). The presence of only intestines in the hernia content was a protective factor (OR: 0.615, p=0.001). CONCLUSION: The mortality in the first year of life in patients with congenital diaphragmatic hernia in this study was 61% in the years 2005-2015. Among the prognostic factors that demonstrated a significant effect, pulmonary hypoplasia had the greatest impact.

Endometriosis infiltrating the pelvic floor muscles with histopathological correlation-A case report.

We report the case of a 29-year-old woman with deep infiltrating endometriosis who underwent robotic nerve-sparing surgery for resection of all visible lesions infiltrating pelvic and extrapelvic sites. Painful symptoms included severe dysmenorrhea, menstrual dyschezia and stranguria, with no improvement in response to hormonal treatment. The location on physical examination of a painful retrocervical nodule was identified by magnetic resonance imaging to be infiltrating the right parametrium/paracervix. During surgery, this nodule was recognized as an important retrocervical/rectovaginal lesion infiltrating the pelvic floor (i.e. levator ani and coccygeus), and was histopathologically confirmed as endometriosis infiltrating the skeletal pelvic floor muscles. A Pubmed search of the MEDLINE database in March (2019) found no publication reporting histopathologic confirmation of endometriosis infiltrating the pelvic floor muscles.

Interrelationships among endometriosis-related pain symptoms and their effects on health-related quality of life: a sectional observational study.

OBJECTIVE: To assess the correlation between different pain symptoms and different domains of women's health-related quality of life (HRQoL). METHODS: Seventy-seven women with deep infiltrating endometriosis were successively enrolled between June 2011 and August 2013 while being prepared to undergo laparoscopy due to pain and/or infertility. We quantified the intensities of dysmenorrhea, deep dyspareunia, chronic pelvic pain, and dyschezia (menstrual and non-menstrual) using a 11-point visual analog scale (VAS: 0-10) and the validated full versions of the Short Form 36 (SF36) and Endometriosis Health Profile (EHP30) questionnaires to assess HRQoL. The pain symptoms were considered simultaneously in a hierarchical agglomerative clustering method (exploratory multivariate approach) and the associations among scores were tested by bivariate correlation. RESULTS: Dysmenorrhea showed the lowest similarity on to the multivariate cluster analysis and no statistically significant correlation with the other pain symptoms: deep dyspareunia (P=0.244), chronic pelvic pain (P=0.108), menstrual dyschezia (P=0.238), and non-menstrual dyschezia (P=0.380). Dysmenorrhea and chronic pelvic pain were the main symptoms correlated with all domains of the SF36 and the EHP30 (core instrument) questionnaires (P<0.05). CONCLUSION: Dysmenorrhea and chronic pelvic pain were independent factors associated with HRQoL.

Urodynamic observations and lower urinary tract symptoms associated with endometriosis: a prospective cross-sectional observational study assessing women with deep infiltrating disease.

INTRODUCTION AND HYPOTHESIS: The objective was to assess the association between lower urinary tract disease (LUTD) and the presence of endometriosis at different anatomical sites. METHODS: Our prospective cross-sectional observational study evaluated 138 women with deep infiltrating endometriosis who had undergone preoperative evaluation of urodynamics and detailed assessment of lower urinary tract symptoms between August 2013 and May 2016. After laparoscopy, the anatomical sites of histologically confirmed endometriosis lesions were mapped. RESULTS: The presence of endometriosis in the bladder demonstrated significant negative angular coefficients for bladder compliance (mL/cmH2O) (P = 0.007; B = -54.65; 95%CI: -93.76 to -15.51) and for maximum cystometric capacity (mL; P = 0.001; B = -39.79; 95%CI: -62.51 to -17.06), whereas endometriosis in the parametrium showed significant positive coefficients for opening pressure (cmH2O) (P = 0.016; B = 5.89; 95%CI: 1.10-10.69) and post-void residual (mL) (P = 0.015; B = 31.34; 95%CI: 6.14-56.55). The presence of endometriosis in the bladder was a statistically significant independent predictor of low bladder compliance (P < 0.001; OR = 30.10; 95%CI: 9.48-95.55), whereas endometriosis in the parametrium was a statistically significant independent predictor of both abnormal residual urine (P = 0.019; OR = 5.21; 95%CI: 1.32-20.64) and bladder outlet obstruction (P = 0.011; OR = 7.91; 95%CI: 1.61-38.86). Correspondence analysis suggested two possible independent ways through which endometriosis acts on the genesis of urinary dysfunctions. CONCLUSIONS: Our findings strongly suggest that endometriosis involving the bladder might disturb storage function, whereas endometriosis in the parametrium disturbs the voiding phase.

Hemostasis with the Ultrasonic Scalpel.

BACKGROUND AND OBJECTIVES: The ultrasonically activated scalpel is a surgical instrument that is used in minimally invasive surgery to safely cut and seal vessels. This study reported the experimental observations of the use of a laparoscopic ultrasonic scalpel, including its safety and feasibility. in sealing vessels of different diameters in an in vivo animal model during both physiological and supraphysiological blood pressure (BP) conditions. METHODS: One healthy female swine was used. We performed resections of the omentum, biopsies in different regions of the liver, and a hysterectomy. Vessels with diameters ranging from 2 to 10 mm were sealed with the ultrasonic scalpel under regular hemodynamic conditions and during pharmacologically induced arterial hypertension (BP challenge). RESULTS: For 10 random cuts made in the omentum and during the hysterectomy, the ultrasonic scalpel was effective and fast, with no immediate or delayed bleeding. Bipolar energy, sutures, and hemoclips were not required to control bleeding. No bleeding was observed in sealed vessels up to 8 mm, even during BP challenges sustained for longer than 5 minutes. When testing vessels of 10 mm, bleeding occurred in 1 common iliac vein before 10 minutes of waiting (the point of bleeding was easily identified) and bleeding occurred in 1 of the common iliac arteries during the BP challenge. CONCLUSION: Our findings corroborate that the ultrasonic scalpel can safely seal arteries up to 8 mm in diameter to prevent or control bleeding during laparoscopic procedures, even when BP exceeds normal levels.

Risk of urinary retention after nerve-sparing surgery for deep infiltrating endometriosis: A systematic review and meta-analysis.

AIMS: Recently, nerve-sparing (NS) techniques have been incorporated in surgeries for deep infiltrating endometriosis (DIE) to prevent urinary complications. Our aim was to perform a systematic review and meta-analysis to assess the risk of urinary retention after NS surgery for DIE compared with classical (non-NS) techniques. METHODS: Following the MOOSE guidelines for systematic reviews of observational studies, data were collected from published research articles that compared NS techniques with non-NS techniques in DIE surgery, with regard to post-operative urinary complications. INCLUSION CRITERIA: randomized clinical trials, intervention or observational (cohort and case-control) studies assessing women who underwent surgery for painful DIE. EXCLUSION CRITERIA: cancer surgery and women submitted to bladder or ureteral resections. The respective relative risks (RR) and 95% confidence intervals (CI) were extracted and a forest plot was generated to show individual and combined estimates. RESULTS: Preliminarily, 1,270 potentially relevant studies were identified from which four studies were selected. A meta-analysis was performed to assess the risk of urinary retention at discharge and 90 days after surgery. We found a common RR of 0.19 [95%CI: 0.03-1.17; (I2 = 50.20%; P = 0.09)] for need of self-catheterization at discharge in the NS group in relation to the conventional technique. Based on two studies, common RR for persistent urinary retention (after 90 days) was 0.16 [95%CI: 0.03-0.84]. CONCLUSIONS: Our results suggest significant advantages of the NS technique when considering the RR of persistent urinary retention. Controlled studies evaluating the best approach to manage the urinary tract after complex surgery for DIE are needed. Neurourol. Urodynam. 36:57-61, 2017. © 2015 Wiley Periodicals, Inc.

Predictors of fluid intravasation during operative hysteroscopy: a preplanned prospective observational study with 200 cases.

PURPOSE: To verify the predictors of intravasation rate during hysteroscopy. METHODS: Prospective observational study (Canadian Task Force classification II(-1)). All cases (n=200 women; 22 to 86 years old) were treated in an operating room setting. Considering respective bag overfill to calculate water balance, we tested two multiple linear regression models: one for total intravasation (mL) and the other for absorption rate (mL.min(-1)). The predictors tested (independent variables) were energy (mono/bipolar), tube patency (with/without tubal ligation), hysterometry (cm), age ≤ 50 years, body surface area (m(2)), surgical complexity (with/without myomectomy) and duration (min). RESULTS: Mean intravasation was significantly higher when myomectomy was performed (442 ± 616 versus 223 ± 332 mL; p<0.01). In the proposed multiple linear regression models for total intravasation (adjusted R(2)=0.44; p<0.01), the only significant predictors were myomectomy and duration (p<0.01).In the proposed model for intravasation rate (R(2)=0.39; p<0.01), only myomectomy and hysterometry were significant predictors (p=0.02 and p<0.01, respectively). CONCLUSIONS: Not only myomectomy but also hysterometry were significant predictors of intravasation rate during operative hysteroscopy.

Predictors of fluid intravasation during operative hysteroscopy: a preplanned prospective observational study with 200 cases / Preditores de intravasamento durante histeroscopia cirúrgica: um estudo observacional prospectivo com 200 casos

PURPOSE: To verify the predictors of intravasation rate during hysteroscopy. METHODS: Prospective observational study (Canadian Task Force classification II-1). All cases (n=200 women; 22 to 86 years old) were treated in an operating room setting. Considering respective bag overfill to calculate water balance, we tested two multiple linear regression models: one for total intravasation (mL) and the other for absorption rate (mL.min-1). The predictors tested (independent variables) were energy (mono/bipolar), tube patency (with/without tubal ligation), hysterometry (cm), age≤50 years, body surface area (m2), surgical complexity (with/without myomectomy) and duration (min). RESULTS: Mean intravasation was significantly higher when myomectomy was performed (442±616 versus 223±332 mL; p<0.01). In the proposed multiple linear regression models for total intravasation (adjusted R2=0.44; p<0.01), the only significant predictors were myomectomy and duration (p<0.01).In the proposed model for intravasation rate (R2=0.39; p<0.01), only myomectomy and hysterometry were significant predictors (p=0.02 and p<0.01, respectively). CONCLUSIONS: Not only myomectomy but also hysterometry were significant predictors of intravasation rate during operative hysteroscopy. .

OBJETIVO: Testar preditores do ritmo de intravasamento durante histeroscopia cirúrgica. MÉTODOS: Estudo prospectivo observacional (classificação: Canadian Task Force II-1) incluindo casos conduzidos em centro cirúrgico (n=200 mulheres; 22 a 86 anos de idade). Considerando os erros de aferição nas embalagens de solução de irrigação para calcular o balanço hídrico, nós testamos dois modelos de regressão linear múltipla: um para intravasamento total (mL) e outro para ritmo de intravasamento (mL.min-1). Os preditores testados (variáveis independentes) foram energia (mono/bipolar), permeabilidade tubária (com/sem ligadura tubária), histerometria (cm), status ovariano (idade≤50 anos), área de superfície corporal (m2), complexidade de cirurgia (com/sem miomectomia) e tempo de ressecção (min). RESULTADOS: O intravasamento médio foi significativamente maior quando miomectomia foi realizada (442±616 versus 223±332 mL, p<0,01). No modelo proposto para intravasamento total (R2 ajustado=0,44; p<0,01), os únicos preditores significativos foram miomectomia e tempo de duração (p<0,01). No modelo proposto para a taxa de intravasamento (R2=0,39; p<0,01), somente miomectomia e histerometria foram preditores significativos (p=0,02 e p<0,01, respectivamente). CONCLUSÕES: Não só a miomectomia mas também a histerometria são preditores significativo da taxa de intravasamento durante histeroscopia cirúrgica. .

The influence of changes in lifestyle and mercury exposure in riverine populations of the Madeira River (Amazon Basin) near a hydroelectric project.

In the Amazon Basin, naturally occurring methylmercury bioaccumulates in fish, which is a key source of protein consumed by riverine populations. The hydroelectric power-plant project at Santo Antônio Falls allows us to compare the Hg exposure of riverine populations sparsely distributed on both sides of the Madeira river before the area is to be flooded. From 2009 to 2011, we concluded a population survey of the area (N = 2,008; representing circa 80% of community residents) that estimated fish consumption and mercury exposure of riverine populations with different degrees of lifestyle related to fish consumption. Fish samples from the Madeira river (N = 1,615) and 110 species were analyzed for Hg. Hair-Hg was significantly lower (p < 0.001) in less isolated communities near to the capital of Porto Velho (median 2.32 ppm) than in subsistence communities in the Cuniã Lake, 180 km from Porto Velho city (median 6.3 ppm). Fish Hg concentrations ranged from 0.01 to 6.06 µg/g, depending on fish size and feeding behavior. Currently available fish in the Madeira river show a wide variability in Hg concentrations. Despite cultural similarities, riparians showed hair-Hg distribution patterns that reflect changes in fish-eating habits driven by subsistence characteristics.

Iron status as a covariate in methylmercury-associated neurotoxicity risk.

Intrauterine methylmercury exposure and prenatal iron deficiency negatively affect offspring's brain development. Since fish is a major source of both methylmercury and iron, occurrence of negative confounding may affect the interpretation of studies concerning cognition. We assessed relationships between methylmercury exposure and iron-status in childbearing females from a population naturally exposed to methylmercury through fish intake (Amazon). We concluded a census (refuse <20%) collecting samples from 274 healthy females (12-49 years) for hair-mercury determination and assessed iron-status through red cell tests and determination of serum ferritin and iron. Reactive C protein and thyroid hormones was used for excluding inflammation and severe thyroid dysfunctions that could affect results. We assessed the association between iron-status and hair-mercury by bivariate correlation analysis and also by different multivariate models: linear regression (to check trends); hierarchical agglomerative clustering method (groups of variables correlated with each other); and factor analysis (to examine redundancy or duplication from a set of correlated variables). Hair-mercury correlated weakly with mean corpuscular volume (r=.141; P=.020) and corpuscular hemoglobin (r=.132; .029), but not with the best biomarker of iron-status, ferritin (r=.037; P=.545). In the linear regression analysis, methylmercury exposure showed weak association with age-adjusted ferritin; age had a significant coefficient (Beta=.015; 95% CI: .003-.027; P=.016) but ferritin did not (Beta=.034; 95% CI: -.147 to .216; P=.711). In the hierarchical agglomerative clustering method, hair-mercury and iron-status showed the smallest similarities. Regarding factor analysis, iron-status and hair-mercury loaded different uncorrelated components. We concluded that iron-status and methylmercury exposure probably occur in an independent way.