Management of pelvic organ prolapse of ruptured and extruded bladder from a rare complication of vaginal hysterectomy: a case presentation.

BACKGROUND: The prolapse of a ruptured and extruded bladder after vaginal hysterectomy is rare in clinical practice. We report the case of a significant mass that prolapsed from the vagina after a vaginal hysterectomy in a multiparous postmenopausal woman. CASE PRESENTATION: A 67-year old multiparous postmenopausal Chinese woman was found to have a significant mass extruding from the vagina after a vaginal hysterectomy. The mass was a ruptured and everted bladder, and the diagnosis was confirmed after physical and imaging examinations and urethral catheterization. The patient underwent an emergency operation for mass reduction, bladder repair, and partial colpocleisis under general anesthesia. She recovered without prolapse or urinary drainage complications after 35 months of follow-up. CONCLUSIONS: The present case serves as a guide for the management of patients with pelvic organ prolapse. The condition of patients should be carefully evaluated before surgery, and individualized operation should be performed. Careful postoperative follow-up is crucial for the timely exclusion of complications, especially in elderly patients with persistently increased abdominal pressure.

A prospective randomized controlled trial comparing two different treatments of intrauterine adhesions.

RESEARCH QUESTION: Intrauterine adhesions (IUA) are primarily caused by trauma to the endometrium, and hysteroscopy is presently the main treatment for IUA. However, high rates of post-operative adhesion re-formation remain a problem. In this study, the combination of an intrauterine device (IUD) with a Foley catheter and the balloon uterine stent were investigated to evaluate their efficacy in preventing adhesion re-formation and the subsequent reproductive outcomes in patients with moderate to severe adhesions. DESIGN: A prospective randomized controlled study was conducted in a university-affiliated hospital. A total of 171 women with Asherman's syndrome were initially recruited between August 2016 and December 2017 and were randomized to undergo either balloon uterine stent insertion or placement of a contraceptive IUD plus a Foley catheter after hysteroscopic adhesiolysis. Reduction of adhesion scores, incidence of adhesion re-formation, changes in menstrual flow and reproductive outcomes were analysed. RESULTS: A total of 118 participants were eligible for analysis. The American Fertility Society (AFS) scores were not significantly different between groups before hysteroscopic adhesiolysis. At the second-look hysteroscopy, the AFS scores and adhesion recurrence rates were significantly higher in the balloon uterine stent group compared with the combination group (P < 0.01 and P = 0.024, respectively). There were no statistically significant differences in pregnancy and live birth rates between the two groups. CONCLUSIONS: The combination of an IUD and a Foley balloon catheter had better efficacy in preventing adhesion re-formation than the balloon uterine stent alone; however, it did not produce better reproductive outcomes.

Synthesis and crystal structure of new dicopper(II) complexes with N,N'-bis-(dipropylenetriamine)oxamide as bridging ligand: effects of the counterions on DNA/protein-binding property and in vitro antitumor activity.

Two new dicopper(II) complexes bridged by N,N'-bis(dipropylenetriamine)oxamide (H2oxdipn), namely, [Cu2(oxdipn)](pic)2(1) and [Cu2(oxdipn)(ClO4)2] (2), where pic represents picrate ion, have been synthesized and characterized by elemental analyses, molar conductance measurements, IR and electronic spectral studies, and X-ray single crystal diffraction. In both dicopper(II) complexes, the two copper(II) ions are bridged by trans-oxdipn ligand with the Cu⋯Cu separations of 5.2536(15) and 5.231(2)Å, respectively. The copper(II) ion in complex 1 has a square-planar coordination geometry, while that in 2, a square-pyramidal. Linked with classical hydrogen bonds, the molecules of complex 1 consist of a one-dimensional chain, while complex 2 molecules result in a two-dimensional structure. Numerous hydrogen bonds link complex 1 or 2 into a 2-D infinite network. In vitro cytotoxicity experiment shows that the two dicopper(II) complexes exhibit cytotoxic effects against the selected tumor cell lines. The reactivity towards herring sperm DNA (HS-DNA) and bovine serum albumin (BSA) reveals that the two dicopper(II) complexes can interact with the DNA in the mode of intercalation, and effectively quench the intrinsic fluorescence of BSA via a static mechanism. The influence of different counterions in this kind of dicopper(II) complexes on DNA/BSA-binding properties, and the in vitro cytotoxic activities was investigated.