Incidence of maternal and neonatal outcomes in pregnancies complicated by ovarian masses.

PURPOSE: The purpose of our study is to estimate the incidence of adnexal mass and ovarian cancers during pregnancy and to evaluate their effects on obstetrical and fetal outcomes. METHODS: We conducted a population-based cohort study using data from The Healthcare Cost and Utilization Project-Nationwide Inpatient Sample. Cases of ovarian mass during delivery were identified using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). Women were categorized into subgroups of malignant and benign masses. Logistic regression analysis was used to evaluate maternal and fetal outcomes. RESULTS: There were 7,785,583 deliveries between 2003 and 2011, of which 19,591 were diagnosed with ovarian masses during delivery, representing 0.25 % of all deliveries. Among these, 1:200 were malignant. The overall malignancy rate was 0.12/10,000 deliveries. Apart from the increased rate of cesarean section, OR 5.92 (95 % CI 4.12-8.40), and the risk of thrombosis, OR 5.52 (95 % CI 1.96-15.53), there was no significant increase in maternal morbidity or mortality. Prematurity, OR 2.24 (95 % CI 1.48-3.40), was the only significant newborn risk in women with malignant ovarian tumors. Newborns of women with an ovarian mass had comparable risks of intrauterine growth restriction, preterm rupture of membrane and intrauterine death. CONCLUSION: The diagnosis of ovarian mass is rare during pregnancy and it is associated with an extremely low malignancy rate. Pregnant woman with a confirmed malignant ovarian tumor should be counseled regarding risks of prematurity, thrombosis and hysterectomy.

Mixed primary and secondary vaginal calculi: a case report.

Vaginal calculi are classified according to the pathogenesis of calculus formation. Primary and secondary vaginal calculi. In this article, we present an interesting case that we believe to be a mixed primary and secondary vaginal calculi in which both originated as a result of a vesicovaginal fistula (VVF) and stitches found in the vagina. Although vaginal calculi are a rare disease, a high index of suspicion is needed, especially in patients with a history of gynecological procedures. Since the high recurrence rate of VVF along with its complications, more frequent follow-up and physical examination are required to avoid the recurrence of the disease.

Xanthogranulomatous inflammation of urachus: A case report.

The urachus is a midline tubular structure that extend between bladder dome and umbilicus which result from incomplete regression during normal development. Defective obliteration of the urachus is rare and can result in urachal abnormalities, most commonly malignant masses. Xanthogranulomatous urachal masses are rare forms of chronic inflammatory processes with only few reported cases. Differentiating malignant from benign urachal lesion is challenging due to lack of typical clinical and radiologic manifestations, coupled with limited diagnostic experience or awareness. We present an initial misdiagnosis of urachal carcinoma, which was revealed to be benign xanthogranulomatous inflammation of urachus on postoperative histopathological examination.

Leiomyosarcoma Invading the Vena Cava: A Case Report.

Leiomyosarcoma is an aggressive soft tissue tumor originating from smooth muscle cells typically of the uterus, gastrointestinal, or genitourinary system. The most common site of leiomyosarcoma of soft tissue is the retroperitoneum, accounting for 50% of all cases. The majority of patients are asymptomatic, which may be due to the large retroperitoneal cavity. However, when symptoms do occur, they are vague in nature. The most common growth pattern is an entirely extravascular mass. We are presenting an interesting case of a 65-year-old lady, who was referred to our hospital as a case of large left retroperitoneal mass with left renal vein thrombosis. She was biopsied and diagnosed with leiomyosarcoma with invasion into descending colon and the left renal vein, which led to renal vein thrombus. In the last few decades, there is a lack of studies about leiomyosarcoma invading the renal vein and Inferior Vena Cava (IVC). As far as we know, the leiomyosarcoma of a major blood vessel is extremely rare. Since leiomyosarcoma often has a late presentation with the advanced stage when detected, a high index of suspicion is needed to be detected early and avoid such a complication.

Outcome of stented versus unstented mid-shaft to distal hypospadias repair.

Aims: We compared the outcomes of unstented repair (UR) versus stented repair (SR) in patients with mid-shaft to coronal hypospadias (HS) to elucidate if SR has any advantage over the UR. Materials and Methods: We retrospectively studied our mid-shaft to coronal HS repair patients between January 2013 and January 2018. We recorded variables such as degree of HS, age at repair, surgeon, type of repair, suture used, stent usage, and standard early and late complications. Relative risk (RR) was calculated and P < 0.05 was considered significant. Results: We included 120 patients (63 UR, 57 SR). There was no statistically significant difference in any parameters in both the groups. All had either tubularized incised plate or Thiersch-Duplay procedure. Urethroplasty was done with PDS 6/0 in all cases. Trainees performed two-third of the repairs under variable supervision. Early complications included one UR patient having urinary retention needing insertion of urethral catheter, five SR patients having bleeding/swelling, and three UR having dysuria. All were managed conservatively. For late complications, 98 patients were available (UR: 51, SR: 47) with fistula in 17 (17.3%), UR 8 (15.6%) versus SR 9 (19.1%) (P = 0.5, RR = 1.2) meatal stenosis in 3, UR 3 versus SR 0 (P = 0.06, RR = 6.4) and glanular dehiscence 6, UR 4 versus SR 2 (P = 0.25, RR = 1.8). Conclusion: There were no statistically significant differences in the short-term complications between UR and SR for HS. In the long term, RR for meatal stenosis is higher in UR.

Priapism for 10 days in a patient with SARS-CoV-2 pneumonia: a case report.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been linked to thromboembolic complications. Priapism has been reported only once in link to SARS-CoV2. Here we report the second case of priapism in a patient with SARS-CoV2; our case is unique in being that the patient had priapism for 10 days while being hospitalized. We discuss potential causes and possible prevention strategies. The patient was managed by aspiration and Phenylephrine injection and achieved detumescence and reported normal erection at 2 weeks follow-up.

Seasonal variation in the incidence of acute renal colic.

Urolithiasis is a prevalent medical disease affecting the general population. Many epidemiological studies reported an association between a geographic area with a high mean daily temperature and urolithiasis disease. However, it is unclear if the seasonal variation in a high temperature geographical area will affect the acute presentation of renal colic to the emergency department. The aim of this study was to identify the effect of the seasonal variation on the presentation with acute urolithiasis disease. The design was a retrospective chart review, using the database in King Abdulaziz Medical City that was retrieved by the data management office in King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia. The study period was from January 26, 2016, to the end of December 2019. All patients who presented with renal colic, and diagnosed with urolithiasis using a noncontrast-enhanced computed tomography scan, have been included. A total of 1057 patients were included in this study. The majority (71.24%, n = 753) were male, and the mean age was 42.33 ± 16.12 years. The highest proportion presented in summer (31.22%), followed by spring (26.87%), fall (24.12%), and winter (17.79%). The majority of the sample (84.77%) presented with ureteral stones, and 15.23%with kidney stones. Most of the sample (78.33%) had no history of previous stone formation, with 21.67% being current stone former. The acute presentation with urolithiasis is higher during summer, followed by spring, fall, and winter. A public educational program is highly recommended to increase awareness about stone formation and the appropriate avoidance methods. To this end, additional research is required to understand the stone composition and appropriate methods to avoid developing urolithiasis.

The yield of microscopic varicocelectomy in men with severe oligospermia.

INTRODUCTION: Varicocele is detected in 35%-50% of men with primary infertility and up to 81% with secondary infertility. Various studies have shown that varicocele is related to testicular hypotrophy and impaired spermatogenesis. The effect of varicocelectomy in mild-to-moderate male factor infertility has been well reported. However, only a few studies addressed the impact of varicocelectomy in severe oligospermia. METHODS: We included 45 patients with severe oligospermia (<5 million/mL) who underwent microsurgical varicocelectomy between May 2014 and November 2017. Results of semen analysis taken at 6 months after varicocelectomy were compared and patients were divided into responders and nonresponders. Chi-square was used to compare the preoperative and postoperative sperm count, motility, and volume. RESULTS: After 6 months only one patient was found to be a responder with a pre- to post-operative motility of 45%-74% and a sperm concentration of 1 million/mL to 28.1 million/mL. There was a significant improvement in the mean sperm concentration after varicocelectomy which improved from 1.31 million/mL to 5.32 million/mL. However, a significant decrease in sperm motility was noted which decreased from 35.62% to 28.64% postoperatively. Postoperative semen volume increased from 2.56 mL to 3.19 mL, but this difference was not found to be statistically significant (P > 0.05). Four patients (8.9%) were found to have azoospermia after a 6-month follow-up. In these four patients who turned azoospermic had count <50,000 sperm/mL, two of them had a history of cryptospermia before varicocelectomy. Ejaculate sperm returned in two of these four patients in long-term follow-up (>6 months). CONCLUSION: The magnitude of improvement after microsurgical varicocelectomy for severely oligospermic patients is less profound than reported in mild male factor infertility.

Cytoreductive Surgery And Hyperthermic Intraperitoneal Chemotherapy For Recurrent Ovarian Cancer: The First Reported Experience From Saudi Arabia.

OBJECTIVES: To report our pilot experience (feasibility, morbidity and postoperative outcomes) of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for the treatment of patients with recurrent ovarian cancer and peritoneal carcinomatosis. METHODS: Thirty nine patients were retrospectively analyzed for perioperative details. RESULTS: The vast majority of patients had platinumsensitive disease (69.2%). Complete (CC-0) and incomplete (CC-1/2) resections were achieved in 24 (61.5%) and 15 (38.5%) patients, respectively. The median peritoneal cancer index (PCI) was 14 (range: 2-28). Cisplatin (50 mg/m2) and doxorubicin (15 mg/m2) was the most frequently used HIPEC regimen (87.2%). No intraoperative morbidity/mortality happened. A total of eight patients developed III-IV postoperative complications (20.5%). Median follow-up time was 41 months (range:3-106). No 60 day readmission/mortality happened. At the last date of follow-up, there were 13 patients who were alive without disease (33.4%); mortality occurred in 10 patients (25.6%). For all patients, the mean diseasefree survival (DFS) and overall survival (OS) were 46.3 months (95% CI: 33.7-58.9) and 81 months (95% CI: 68.6-93.3) respectively. PCI >14 was correlated with statistically significant poor DFS and OS at univariate analysis (p=0.046). When compared to CC-0, CC-1/2 was correlated with poor DFS and OS, however, without statistical significance. Cox multivariate analyses of DFS and OS failed to demonstrate PCI score, CC score and platinum-sensitivity as independent prognosticfactors of DFS and OS. CONCLUSIONS: Our study demonstrated the feasibility, safety and favorable clinical outcomes of CRS and HIPEC in patients with recurrent ovarian cancer and peritonealcarcinomatosis.

Preoperative leukocytosis correlates with unfavorable pathological and survival outcomes in endometrial carcinoma: A systematic review and meta-analysis.

AIM: To meta-analytically examine the frequency and prognostic impact of preoperative leukocytosis in endometrial carcinoma (EC). METHODS: Five major databases were searched till 01-February-2021. Studies that evaluated the frequency of preoperative leukocytosis or its correlation with pathological and survival outcomes in EC patients were included. Data were pooled as mean differences (MD), odds ratios (OR), or hazard ratios (HR) with 95% confidence intervals. RESULTS: Nine retrospective studies, with low risk of bias, were included. The pooled prevalence of preoperative leukocytosis was 11.2% (95% CI: 8.2-14.3). There was a significant correlation between preoperative leukocytosis and FIGO stage III-IV (OR = 2.10, 95% CI: 1.60-2.75), ≥50% myometrial invasion (OR = 1.32, 95% CI: 1.02-1.72), lymph node involvement (OR = 1.83, 95% CI: 1.29-2.59), cervical involvement (OR = 2.29, 95% CI: 1.68-3.13), adnexal involvement (OR = 2.17, 95% CI: 1.42-3.31), and tumor size (MD = 1.10 cm, 95% CI: 0.63-1.58). However, preoperative leukocytosis did not significantly correlate with tumor grade II-III, non-endometrioid histology, peritoneal cytology, and lympho-vascular space involvement (p > 0.05). Additionally, preoperative leukocytosis correlated with higher rates of death (OR = 2.85, 95% CI: 2.03-4.00), tumor recurrence (OR = 2.36, 95% CI: 1.21-4.61), and worse overall survival at univariate and multivariate analyses (HR = 2.90, 95% CI: 2.24-3.75 and HR = 2.16, 95% CI: 1.59-2.94, respectively). As for disease-free survival, preoperative leukocytosis emerged as an independent prognostic factor on univariate (HR = 1.27, 95% CI: 1.16-1.39) but not multivariate (HR = 1.08, 95% CI: 1.00-1.18) analyses. CONCLUSIONS: Preoperative leukocytosis is common and correlates with poor pathological and survival outcomes in EC patients.

Stone fragments migration into subcapsular renal hematoma post flexible ureterorenoscopy (unique presentation).

This is a case report of 45-year-old female patient who presented with right flank pain. Abdominopelvic CT scan showed right renal pelvis stone measuring 20 mm. Right flexible ureterorenoscopy with holmium laser was performed in our institute. Postoperatively, she was febrile and pale. Immediate Abdominopelvic CT scan was obtained which revealed a large right subcapular hematoma. Conservative management was maintained for a week. Two months later, repeated Abdominopelvic CT scan showed regression of right subcapsular renal hematoma with stone fragments migration into the perinephric space as a first presentation in the world.

Incidence of malignant ovarian germ cell tumors (MOGCTs) in Saudi Arabia.

Incidence of malignant ovarian germ cell tumors (MOGCTs) in the Saudi Arabian population has not been studied before. Therefore, the primary objective of this study was to define the population-based incidence rates and histopathological types of MOGCTs in the Saudi Arabian population from 1999 to 2008. Our study showed that MOGCTs are a common type of ovarian tumors in the Saudi Arabian population, and the incidence rates and histopathological types are relatively comparable to the international populations with few differences.

Generalized peritonitis secondary to spontaneous perforation of pyometra in a 63-year-old patient.

Spontaneous perforation of pyometra resulting in generalized diffuse peritonitis is extremely uncommon. Herein, we report the case of a 63-year-old woman who presented to emergency department with a 2-day history of severe diffuse abdominal pain, high-grade fever, nausea, and vomiting. Acute abdomen series was done, and upright plain chest radiograph showed free air under diaphragm. A noncontrast-enhanced computed tomography scan showed a significantly distended fluid-filled uterus measuring 10 × 7.8 × 10 cm, in addition to a single focus of perforation involving the uterine fundus and associated with presence of free air within the nondependant area. No evidence of ascites or pelvi-abdominal lymphadenopathy was identified. A preoperative diagnosis of generalized peritonitis secondary to spontaneous perforation of uterus was established. Subsequently, patient underwent urgent exploratory laparotomy which revealed pus-filled uterus with perforated fundus. Diagnosis of generalized peritonitis secondary to spontaneous perforation of pyometra was established. Consequently, patient underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy, as well as thorough drainage and irrigation of pelvi-abdominal cavity. Postoperatively, patient was admitted to intensive care unit. Histopathological examination of uterus was negative for malignancy, and surgical culture grew Streptococcus constellatus. Patient had an uneventful recovery. Moreover, a brief literature review on pyometra is presented.

Successful pregnancy in a 31-year-old peritoneal dialysis patient with bilateral nephrectomy.

Frequency of pregnancy among childbearing age women with end-stage renal disease (ESRD) undergoing long-term periodic dialysis ranges from 1% to 7%. Although pregnancy in dialysis women with ESRD is considered a largely high-risk pregnancy, occurrence of successful pregnancy is not impossible with success rates approaching 70%. Rates of successful pregnancy are greatly impacted by early pregnancy diagnosis and preserved residual renal functions. Herein, to the best of our knowledge, we report the first case of successful pregnancy (despite late diagnosis at 14 weeks of gestation) in a 31-year-old peritoneal dialysis patient with bilateral nephrectomy and no whatsoever preserved residual renal function. Moreover, a literature review on pregnancy in dialysis patients is presented.

Bilateral ectopic hypoplastic uteri attached to bilateral pelvic sidewalls in a 21-year-old patient with primary amenorrhea: the first published report.

Müllerian duct anomalies (MDAs) encompass a group of anatomical malformations resulting from defective development, fusion, migration, or resorption of Müllerian (paramesonephric) ducts during embryonic life. Herein, we report the first case of an exceedingly uncommon MDA (bilateral ectopic hypoplastic uteri attached to bilateral pelvic sidewalls) in a 21-year-old woman who was referred to our tertiary care center as a case of primary amenorrhea for workup and further management.

Myeloid sarcoma of the vulva post-bone marrow transplant presenting as isolated extramedullary relapse in a patient with acute myeloid leukemia.

Myeloid sarcoma is a tumor of myoblasts or immature myeloid cells occurring in an extramedullary site. Myeloid sarcoma of the female genital tract as an isolated initial presentation or isolated relapse is very rare as evidenced from a literature review. We report a case of vulvar myeloid sarcoma presenting as isolated relapse of acute myeloid leukemia (AML) after allogeneic hematopoietic stem cell transplant (HSCT). A 41-year-old female diagnosed with AML M5 achieved remission with chemotherapy and underwent allogeneic HSCT from an HLA-matched sibling donor. The post-transplant period was complicated with chronic graft-versus-host disease. At 10 months post-transplant, she presented with a vulvar mass of six weeks duration. Excisional biopsy of the vulvar mass confirmed the diagnosis of myeloid sarcoma as extramedullary relapse. Bone marrow biopsy was without evidence of leukemia. Involvement of the vulva, vaginal and adjacent cervical area only was confirmed. She received re-induction chemotherapy with clinical regression of both the vulvar, vaginal and the cervical masses; this was followed by radiation therapy to an extramedullary site. The correct diagnosis of myeloid sarcoma, particularly of an isolated mass in the genital area, is important because of its rarity and the need for appropriate institution of therapy.