Vaginal packing after vaginal hysterectomy: systematic review and recommendations.

INTRODUCTION AND HYPOTHESIS: Vaginal packing is often used after vaginal hysterectomy to reduce the risk of haemorrhagic and infectious complications, but the procedure may impair spontaneous bladder emptying and necessitate permanent bladder catheterization, which itself increases the risk of urinary infection, patient bother, delayed discharge, and increased costs. This systematic review was aimed at assessing the complications and outcomes associated with vaginal packing after vaginal hysterectomy. METHODS: We conducted a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement, using the Population, Interventions, Comparators, Outcomes, and Study design (PICOS) framework to define eligibility. Following data synthesis and subgroup analyses, we assessed the certainty of evidence according to GRADE guidance and formulated a clinical recommendation. RESULTS: The review included four clinical trials (involving 337 participants). These provided no clear evidence that vaginal packing led to clinically meaningful reductions in adverse effects, such as vaginal bleeding, hematoma formation, or postoperative vaginal cuff infection. Overall, the intervention produced no clear benefit regarding the predefined outcomes. CONCLUSIONS: Routine vaginal packing after vaginal hysterectomy had no clear benefit on outcomes. We therefore advise against this procedure.

Validación de los criterios ecográficos IOTA en la práctica clínica con marcadores tumorales y patología / Validation of IOTA simple ultrasound rules in clinical practice with tumor markers and pathology / Validation of IOTA simple ultrasound rules in clinical practice with tumor markers and pathology

RESUMEN Objetivos . Correlacionar la ecografía prequirúrgica de las masas anexiales aplicando los criterios IOTA y el diagnóstico anatomopatológico tras intervención quirúrgica. Valorar la utilidad de los marcadores tumorales bioquímicos. Método . Estudio observacional prospectivo en 102 pacientes con diagnóstico ecográfico de tumoración anexial, intervenidas quirúrgicamente entre enero 2017 y febrero 2020. El análisis estadístico se realizó con SPSS 17.0. Las variables categóricas se analizaron mediante pruebas de Fisher y chi-cuadrado, las variables cuantitativas mediante prueba t-student. La concordancia entre la valoración de la ecografía transvaginal mediante criterios IOTA y el resultado anatomopatológico, se estudió con el coeficiente de contingencia y el índice kappa. Resultados . Según criterios IOTA, se clasificó como benignas a 48% de las tumoraciones, como malignas 24,5%, y 27,5% resultaron no clasificables. La anatomía patológica confirmó que 68,1% de las benignas y 72,8% de las malignas fueron correctamente filiadas por la ecografía. La concordancia entre la ecografía transvaginal prequirúrgica y la anatomía patológica fue significativa, con coeficiente de contingencia 0,58, índice kappa 0,47, p <0,05 y con sensibilidad 94,1% y especificidad 92,1%. Los valores de la proteína epididimal humana 4 (HE4) y el antígeno del cáncer 125 (CA 125) tuvieron correlación con la anatomía patológica, también con significación estadística, siendo mayor en las pacientes menopáusicas. Conclusiones . Los criterios IOTA discriminaron de forma satisfactoria las masas benignas de las malignas. La proteína HE4 resultó mejor marcador bioquímico que el CA125.

ABSTRACT Objectives: To determine correlation between preoperative ultrasound evaluation of adnexal masses applying IOTA simple rules and pathology diagnosis. To assess usefulness of biochemical tumor markers in these cases. Methods: A prospective study was performed between January 2017 and February 2020. Patients with suspected ovarian pathology were evaluated using IOTA ultrasound rules and designated as benign or malignant. Findings were correlated with histopathological findings. Collected data was statistically analyzed using the chi-square test and kappa statistical method. Results: During this period, 102 women were eligible for the study. According to IOTA ultrasound criteria, 48% of the adnexal masses were classified as benign, 24.5% malignant and 27.5% were not classifiable. Pathology confirmed 68.1% of benign and 72.8% of malignant tumors were correctly classified by ultrasound. Statistically, the agreement between pre-surgical transvaginal ultrasound and pathology result was significant with contingency coefficient 0.58 and Kappa index 0.47, both with p <0.05 significance. The sensitivity for detection of malignancy with IOTA simple rules was 94.1% and specificity 92.1%. As for biochemical tumor markers, human epididymal protein 4 (HE4) and cancer antigen 125 (CA 125) values had statistically significant correlation with pathology results. Conclusions: IOTA simple rules may be used in clinical practice for diagnosis of ovarian tumors. Human epididymis 4 appeared a better diagnostic tool than CA 125 in discrimination of malignant adnexal masses.

De novo urgency after tension-free vaginal tape versus transobturator tape procedure for stress urinary incontinence.

OBJECTIVE: To determine the frequency of de novo urgency after tension-free vaginal tape (TVT) compared with the transobturator tape (TOT) procedure in women with stress urinary incontinence (SUI). STUDY DESIGN: Prospective study of all consecutive women with urodynamically confirmed SUI undergoing anti-incontinence surgery between January 2000 and January 2008. All procedures were performed by experienced urogynaecologists well trained in TVT and TOT surgery. Assessments were carried out at 1, 6, 12 and, 36 months after surgery. RESULTS: The study population included 366 women (mean age 59.5 years), 243 in the TVT group and 123 in the TOT group. The groups were similar in terms of demographics, preoperative data, and cure rates. De novo urgency occurred in 13.4% of patients at 6 months after surgery, in 19.3% at 12 months, and in 22.1% at 36 months. De novo urgency was significantly more frequent in the TVT group than in the TOT group at 12 (22.2% vs 11.2%, P=0.025), 24 (24.8% vs 12.3%, P=0.033), and 36 (0% vs 24.7%, P=0.034) months. Cure rates were similar in both groups. The final adjusted cure rate was 87.3% (319/366). CONCLUSION: Treatment of SUI using the TOT procedure was associated with a lower rate of de novo urgency.

The Value of Hysterosalpingography following Medical Treatment with Methotrexate for Ectopic Pregnancy.

After an ectopic pregnancy (EP) fertility decreases, mostly due to tubal factor. Hysterosalpingography (HSG) is the most cost-effective tool for tubal patency assessment. Objective. To evaluate the usefulness of a HSG after a medical treatment for an EP, in order to counsel women on the most appropriate way to conceive future pregnancies. Methods. Between 1998 and 2008, 144 patients were submitted to medical treatment for an EP and performed HSG 3 months after the event. Results. 72.2% of normal HSG, 18.8% with unilateral obstruction, 6.3% tubal patency with defect, and 2.8% bilateral obstruction. Conclusion. Routine HSG following medical treatment for an EP does not seem necessary, as it does not change the initial management in 97.2% of the cases, but might be considered in selected risk cases, permitting timely referral of patients to in vitro fertilization.