Benign cystic ovarian teratoma with a fistula into the small and large bowel.

BACKGROUND: Ovarian dermoid cysts are one of the most common benign neoplasms in women. Rarely, serious complications occur that result in life-threatening events such as bowel perforation. This case summarizes one of these complications from clinical presentation to diagnosis and treatment. CASE: A 25-year-old woman with symptoms of small bowel obstruction was found to have a 10-cm dermoid cyst perforating into both her small and large bowel. A primary large bowel repair and small bowel resection with en bloc left salpingo-oophorectomy and small bowel side-to-side reanastomosis was performed. CONCLUSION: This case illustrates the rare formation of a fistula between a dermoid cyst and the small and large bowel. Awareness of the clinical and radiologic findings in these cases is important to avoid further complications.

Randomized trial of estradiol vaginal ring versus oral oxybutynin for the treatment of overactive bladder.

OBJECTIVE: The aim of this study was to compare the efficacy of the ultralow-dose estradiol vaginal ring with that of oral oxybutynin in the treatment of overactive bladder in postmenopausal women. METHODS: Postmenopausal women with an overactive bladder were recruited from the general gynecology clinic. Participants were randomized to receive either the ultralow-dose estradiol vaginal ring or oral oxybutynin for 12 weeks. The primary outcome was a decrease in the number of voids in 24 hours. The secondary outcomes were quality-of-life questionnaires, vaginal pH levels, and vaginal maturation index. RESULTS: Fifty-nine women were enrolled. Thirty-one were randomized to receive oxybutynin, whereas 28 received the estradiol vaginal ring. Women who received oxybutynin had a mean decrease of 3.0 voids per day, and women who received the vaginal ring had a mean decrease of 4.5 voids per day, with no significant difference between the groups. There was a significant improvement in Urogenital Distress Inventory and Incontinence Impact Questionnaire scores in both groups, with no significant difference in improvement between the two groups. CONCLUSIONS: Ultralow-dose estradiol-releasing vaginal ring and oral oxybutynin seem to be similarly effective in decreasing the number of daily voids in postmenopausal women with overactive bladder.