Female urinary incontinence in China after 15 years' efforts: Results from large-scale nationwide surveys.

Urinary incontinence (UI) is a disease that quietly yet seriously impacts women's health and represents a global health burden that is often neglected. This study aims to systematically assess the prevalence and dynamics of female UI in China, and can inform further policies and have international implications. This study used three nationwide investigations: A national cross-sectional survey in 2021; another nationwide cross-sectional survey in 2006; and data regarding the institutions and physicians providing pelvic floor rehabilitation services from 2005 to 2019. The weighted prevalence of female UI and its subtypes, including stress UI (SUI), urgency UI (UUI), and mixed UI (MUI), were estimated as primary outcomes. Knowledge, attitude and care-seeking behaviors of UI were evaluated. It was found that the weighted prevalence of female UI was 16.0 % (95% CI, 13.3 %-19.1%) with SUI remaining the predominant subtype (7.0%) in 2021, followed by MUI (6.5%) and UUI (1.9%). The estimated absolute number of Chinese adult women with UI was 85.8 million in 2021. 52.7% (95% CI, 45.9%-59.4 %) of women were aware that UI was a medical condition, and only 10.1% of women with UI sought health care. After 15 years of development, there were 8400 pelvic floor rehabilitation institutions and nearly 10,000 relevant physicians in China-they were found to be associated with UI prevalence. The UI prevalence in China was significantly lower in 2021 compared to that in 2006. Despite the achievement, UI remains a public health problem, especially given China's fast aging and three-child policy. More innovations, especially those that can facilitate care seeking, are needed to address this prevalent yet treatable condition.

Recurrent human 16p11.2 microdeletions in type I Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome patients in Chinese Han population.

BACKGROUNDS: Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome, a severe congenital malformation of the female genital tract, is a highly heterogeneous disease which has no clear etiology. Previous studies have suggested that copy number variations (CNVs) and single-gene mutations might contribute to the development of MRKH syndrome. In particular, deletions in 16p11.2, which are suggested to be involved in several congenital diseases, have been reported in Chinese type II MRKH patients and European MRKH patients. However, few CNVs including 16p11.2 microdeletions were identified in Chinese type I MRKH cases although it accounted for the majority of MRKH patients in China. Thus, we conducted a retrospective study to identify whether CNVs at human chromosome 16p11.2 are risk factors of type I MRKH syndrome in the Chinese Han population. METHODS: We recruited 143 patients diagnosed with type I MRKH between 2012 and 2014. Five hundred unrelated Chinese without congenital malformation were enrolled in control group, consisting of 197 from the 1000 Genomes Project and 303 from Fudan University. Quantitative PCR, array comparative genomic hybridization, and sanger sequencing were conducted to screen and verify candidate variant. RESULTS: Our study identified recurrent 16p11.2 microdeletions of approximately 600 kb in two out of the 143 type I MRKH syndrome patients using high-density array-based comparative genomic hybridization (aCGH), while no 16p11.2 deletion was found in the control group. We did not find any mutations in TBX6 gene in our samples. CONCLUSIONS: The results of the study identify 16p11.2 deletion in Chinese MRKH I patients for the first time, as well as support the contention that 16p11.2 microdeletions are associated with MRKH syndrome in both types across populations. It is suggested that 16p11.2 microdeletions should be included in molecular diagnosis and genetic counseling of female reproductive tract disorders.

Comparison of the modified laparoscopic Vecchietti and Davydov colpoplasty techniques in Mayer-Rokitansky-Küster-Hauser syndrome: A long-term follow-up analysis.

AIMS: To introduce and compare the modified laparoscopic Vecchietti and Davydov techniques for vaginoplasty in patients with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome. Moreover, the long-term treatment of vaginal agenesis was followed-up. METHODS: This comparative retrospective cohort study enrolled a total of 53 women with MRKH syndrome. The patients underwent surgical creation of a neovagina including 32 patients who underwent the modified laparoscopic Vecchietti technique, and 21 patients who underwent the modified laparoscopic Davydov technique from January 2009 to February 2019. The perioperative parameters, complications, anatomical, and functional outcomes of the two groups were compared. Patients' sexual functions were evaluated over a long-term follow-up using the female sexual function index (FSFI) and the revised female sexual distress scale (FSDS-R). RESULTS: The medians (25th-75th) of the surgery duration for modified Vecchietti procedures was 50.0 (40.0-59.0) minutes, comparing to 135.0 (117.5-162.5) min for Davydov procedures (p < 0.001). The intraoperative blood loss was 20 (7.5-20.0) mL versus 50.0 (50.0-100.0) mL using the modified Vecchietti and Davydov approaches (p < 0.001), respectively. In the 39 follow-up cases, the lengths of the neovagina of the patients for Vecchietti group versus Davydov group were 7.9 ± 1.0 cm versus 8.6 ± 1.2 cm at 6 months after the vaginoplasty and 8.3 ± 0.7 cm versus 8.5 ± 0.9 cm after 2 years. There was no statistical difference in the FSFI and FSDS-R scores between the two groups. CONCLUSIONS: Both the modified Davydov and Vecchietti laparoscopic procedures successfully achieved optimal anatomic and functional outcomes in treatments of vaginal agenesis. The modified Vecchietti technique is relatively simpler than the modified Davydov technique.

A 14-year multi-institutional collaborative study of Chinese pelvic floor surgical procedures related to pelvic organ prolapse.

BACKGROUND: It has been a global trend that increasing complications related to pelvic floor surgeries have been reported over time. The current study aimed to outline the development of Chinese pelvic floor surgeries related to pelvic organ prolapse (POP) over the past 14 years and investigate the potential influence of enhanced monitoring conducted by the Chinese Association of Urogynecology since 2011. METHODS: A total of 44,594 women with POP who underwent pelvic floor surgeries between October 1, 2004 and September 30, 2018 were included from 22 tertiary academic medical centers. The data were reported voluntarily and obtained from a database. We compared the proportion of each procedure in the 7 years before and 7 years after September 30, 2011. The data were analyzed by performing Z test (one-sided). RESULTS: The number of different procedures during October 1, 2011-September 30, 2018 was more than twice that during October 1, 2004-September 30, 2011. Regarding pelvic floor surgeries related to POP, the rate of synthetic mesh procedures increased from 38.1% (5298/13,906) during October 1, 2004-September 30, 2011 to 46.0% (14,107/30,688) during October 1, 2011-September 30, 2018, whereas the rate of non-mesh procedures decreased from 61.9% (8608/13,906) to 54.0% (16,581/30,688) (Z = 15.53, P < 0.001). Regarding synthetic mesh surgeries related to POP, the rates of transvaginal placement of surgical mesh (TVM) procedures decreased from 94.1% (4983/5298) to 82.2% (11,603/14,107) (Z = 20.79, P < 0.001), but the rate of laparoscopic sacrocolpopexy (LSC) procedures increased from 5.9% (315/5298) to 17.8% (2504/14,107). CONCLUSIONS: The rate of synthetic mesh procedures increased while that of non-mesh procedures decreased significantly. The rate of TVM procedures decreased while the rate of LSC procedures increased significantly. TRIAL REGISTRATION NUMBER: NCT03620565, https://register.clinicaltrials.gov.

Effect of micronutrient pack on micronutrient status and antioxidant capacities among institutional older adults in Shanghai, China.

BACKGROUND AND OBJECTIVES: Older adults are at increased risk of micronutrient deficiency, disrupting the balance of oxidation/antioxidation system and leading to serious health burdens. This study aimed to investigate the effect of micronutrient pack on micronutrient status and oxidative/antioxidative biomarkers in institutional older adults. METHODS AND STUDY DESIGN: Subjects aged 65-100 years were randomly assigned to either intervention group or control group (n=49 each), providing a package of micronutrient pack or placebo daily for three months. The concentrations of micronutrients, malondialdehyde (MDA), glutathione peroxidase (GSH-Px) and superoxide dismutase (SOD) were detected both at baseline and at the end of the study. RESULTS: The changes in concentrations of serum folate (21.1±1.6 vs 0.6±0.5 nmol/L), vitamin B-1 (3.4±0.4 vs -0.2±0.3 nmol/L), vitamin B-2 (11.5±3.3 vs 2.3±1.4 nmol/L), vitamin B-12 (128.8±34.8 vs 13.3±16.0 pmol/L), 25-hydroxyvitamin D (17.8±1.3 vs -0.8±0.5 ng/mL) and plasma zinc (0.6±1.8 vs -9.6±1.9 µmol/L) over 3-months were significantly increased in the intervention group compared with the control group (all p<0.05). While the prevalence of folate, vitamin B-12 and vitamin D deficiencies were significantly decreased after 3-months intervention (all p<0.05). Moreover, changes in serum MDA level (-1.5±0.2 vs 0.2±0.3 nmol/mL) were remarkably reduced, and the activities of serum GSH-Px (1.3±0.3 vs 0.3±0.2 ng/mL) and plasma SOD (14.3±2.4 vs -2.1±2.4 U/mL) were increased in the intervention group than those of in the control group (all p<0.01). CONCLUSIONS: The micronutrient pack among institutional older adults was well-accepted with good compliance and tolerance. The 3-month intervention may improve micronutrient status and enhance antioxidative capacities.

Proportion of Uterine Malignant Tumors in Patients with Laparoscopic Myomectomy: A National Multicenter Study in China.

BACKGROUND: The Food and Drug Administration recently announced that the use of morcellation may cause fibroids or pelvic dissemination and metastasis of uterine sarcoma; therefore, the use of morcellation is limited in the USA. A large sample study is necessary to assess the proportion of uterine malignant tumors found in patients with laparoscopic myomectomy. METHODS: A national multicenter study was performed in China. From 2002 to 2014, 33,723 cases were retrospectively selected. We calculated the prevalence and recorded the clinical characteristics of the patients with malignancy after morcellation application. A total of 62 cases were finally pathologically confirmed as malignant postoperatively. Additionally, the medical records of the 62 patients were analyzed in details. RESULTS: The proportion of postoperative malignancy after morcellation application was 0.18% (62/33,723) for patients who underwent laparoscopic myomectomy. Nearly 62.9% (39/62) of patients had demonstrated blood flow signals in the uterine fibroids before surgery. And, 23 (37.1%) patients showed rapid growth at the final preoperative ultrasound. With respect to the pathological types, 38 (61.3%) patients had detectable endometrial stromal sarcoma, 13 (21.0%) had detectable uterine leiomyosarcoma, only 3 (3.2%) had detectable carcinosarcoma, and 5 (8.1%) patients with leiomyoma had an undetermined malignant potential. CONCLUSIONS: The proportion of malignancy is low after using morcellation in patients who undergo laparoscopic myomectomy. Patients with fast-growing uterine fibroids and abnormal ultrasonic tumor blood flow should be considered for malignant potential, and morcellation should be avoided.

Local recurrent vaginal aggressive angiomyxoma misdiagnosed as cellular angiomyofibroblastoma: A case report.

Aggressive angiomyxoma (AAM) and angiomyofibroblastoma (AMFB) are two rare types of mesenchymal tumors with overlapping clinicopathological features. In certain cases, the differential diagnosis between the two tumors is difficult even for experienced pathologists. The present study reported the case of a well-circumscribed soft tissue mass on the anterior wall of the vagina in a 25-year-old woman. The mass was initially removed without disturbance to the adjacent tissues. The histopathological features included spindle cells in inconspicuous myxoid stroma and a well-demarcated mass without evidence of invasion, which prompted the initial diagnosis of AMFB. After 2 years, a mass returned in the same area and a wide tumor excision was performed. The histopathological examination confirmed the final diagnosis of AAM upon review.

[Comparison study between Vecchietti's and Davydov's laparoscopic vaginoplasty in Mayer-Rokitansky-Küster-Hauser syndrome].

OBJECTIVE: To compare Vecchietti's and Davydov's laparoscopic techniques for vaginoplasty in patients with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome. METHODS: From January 2010 to December 2013, 13 patients underwent the Vecchietti's laparoscopic procedure (Vecchietti group), and 15 patients underwent the Davydov's laparoscopic procedure (Davydov group). Intraoperative parameters and postoperative results were compared. RESULTS: Both of the two groups were successfully treated. The neovagina in both groups were wide with good elasticity, softness and smoothness. The operation time [(39±7) versus (73±11) minutes], the intraoperative blood loss [(21±6) versus (63±10) ml], the anal exsufflation time after surgery [(19±5) versus (28±6) hours] and the recovery period of body temperature after surgery [(35±10) versus (46±10) hours] of the Vecchietti group were less than those of the Davydov group (all P<0.05). But the neovagina length [(8.8±0.5) versus (9.6±0.5) cm] was shorter and the Female Sexual Function Index scale score [26.8±2.0 versus 28.5±1.7] was lower in the Vecchietti group than those in the Davydov group (all P<0.05). The postoperation hospital duration didn't reached statistical difference between the two groups [(7.5±0.9) versus (7.1±0.7) days, P>0.05]. No intraoperative complication occurred. After surgery, 2 patients were found vaginal polyps and 8 patients were suffered from pain in the Davydov group, while all patients were suffered from pain in the Vecchietti group. CONCLUSIONS: Both Vecchietti's and Davydov's laparoscopic techniques are simple, safe and effective surgical methods for vaginal reconstruction. In contrast, the Vecchietti's procedure is more time efficient and minimally invasive, while the Davydov's procedure can get less pain, longer vagina and higher sexual satisfaction.

A Novel Molecular Cytogenetic Finding of Leiomyomatosis Peritonealis Disseminata.

BACKGROUND: Leiomyomatosis peritonealis disseminata (LPD) is a rare disease characterised by the subperitoneal proliferation of smooth muscle cells that form benign nodules. A few studies have aimed to reveal the pathogenesis of LPD without reaching a clear explanation. METHODS: Karyotype analysis and array-comparative genomic hybridization (aCGH) of a human LPD case were performed to evaluate the role of chromosomal abnormalities in LPD pathogenesis. RESULTS: The LPD nodules showed a 45, XX, del(7p), t(11; 17) (q23;q25),-22 de novo karyotype, and the aCGH analysis confirmed these deletions at 7p22.3-p12.1 (1,862,362-52,766,911 bp) and 22q11.23-q13.33 (21,973,915-49,265,116 bp) with lengths of 50.9 Mb and 27.3 Mb, respectively. CONCLUSION: In this study, we described two large novel aberrations - deletions in chromosome 7 and 22 - that might play an important role in LPD disease. These findings might contribute to new insights to unravel the pathogenesis of LPD and develop further clinical treatments. © 2015 S. Karger AG, Basel.

Unilateral ovarian and fallopian tube agenesis in an infertile patient with a normal uterus.

Congenital agenesis of the unilateral adnexa is a condition that has rarely been described in the literature. The current study presents the case of a 26-year-old female who was admitted to the Department of Gynecology at the Women's Hospital of Zhejiang University (Hangzhou, Zhejiang) for primary infertility. The patient was diagnosed with unilateral ovarian and fallopian tubal agenesis, without malformations of the uterus and urinary tract, during diagnostic laparoscopy and hysteroscopy. A literature review was conducted with the aim of determining the possible causes of these anomalies. However, the etiology of the adnexal anomaly remained unclear, although torsion or congenital defects were the most likely explanation. Therefore, the observations of the present study indicate that contralateral tubal pathologies may contribute to sterility.

Increased risk of gonadal malignancy and prophylactic gonadectomy: a study of 102 phenotypic female patients with Y chromosome or Y-derived sequences.

STUDY QUESTION: What is the optimal protocol of management for phenotypic female patients with Y chromosome or Y-derived sequences, in particular for adult patients? SUMMARY ANSWER: Immediate gonadectomy, long-term hormone therapy and psychological care are suggested to be the optimal management for older phenotypic female patients with Y chromosome or Y-derived sequences. WHAT IS KNOWN ALREADY: Phenotypic female patients with Y chromosome or Y-derived sequences are at increasing risk of developing gonadal tumors with age. Early diagnosis and safe guidelines of management for these patients are needed. STUDY DESIGN, SIZE, DURATION: One hundred and two phenotypic women with Y chromosome or Y-derived sequences were included in a straightforward, retrospective-observational study conducted over a period of 26 years from January 1985 to November 2010. PARTICIPANTS/MATERIALS, SETTING AND METHODS: Patients aged 16-34 years presenting to our Academic Department of Gynecology with symptoms of disorders of sex development were subjected to history taking, hormonal evaluation, conventional cytogenetic analysis, PCR, histopathology and immunohistochemistry. Features of the gonads were examined and the outcome of prophylactic gonadectomy evaluated. MAIN RESULTS AND THE ROLE OF CHANCE: Among the patients recruited in our study, 48 patients (47.1%) were diagnosed with complete/partial androgen insensitivity syndrome (CAIS/PAIS) (46XY), 33 cases (32.4%) with gonadal dysgenesis (46XY) and the remaining subjects (20.1%) with mixed gonadal dysgenesis (with sex chromosome structural abnormalities). The total incidence of malignancy was 17.6%. Seventeen patients (16.7%) had gonadoblastoma, while one patient (1.0%) with gonadal dysgenesis had dysgerminoma. Gonadoblastoma were observed in 2/21 patients with sex chromosome structural abnormalities (9.5%), 3/33 patients with gonadal dysgenesis (9.1%), 9/30 patients with CAIS (30.0%) and 3/18 patients with PAIS (16.7%). LIMITATIONS, REASONS FOR CAUTION: Selection bias in this cohort study may affect data interpretation due to the low incidence of disorders of sex development in the general population. WIDER IMPLICATIONS OF THE FINDINGS: The risk for malignant transformation may occur in early life and highly increase with age in patients with Y chromosome or Y-derived sequences. Optimal timing of gonadectomy should be decided by multiple factors including the subgroup of disorder, age and degree of patient's maturity. In addition, gonadal biopsy is suggested when the disease is diagnosed and any evidence of premalignancy warranties gonadectomy. STUDY FUNDING/COMPETING INTEREST(S): This work was supported by the National Key Scientific Research Project (2013CB967404), Natural Science Funds of Zhejiang Province (Y13H04005), Zhejiang Qianjiang talent plan (2013R10027), the Fundamental Research Funds for the Central Universities and Key Projects in the National Science & Technology Pillar Program during the Eleventh Five-Year Plan Period (2012BAI32B04). The authors have no conflicts of interest to declare. TRIAL REGISTRATION NUMBER None.

A Herlyn-Werner-Wunderlich syndrome variant with ipsilateral renal absence and a contralateral duplex collecting system in a 26-year-old female.

Herlyn-Werner-Wunderlich syndrome (HWWS) is a müllerian duct anomaly typically associated with a uterus didelphys with two cervices and two vaginas, one of which is obstructed. A remarkable case of HWWS with contralateral duplex kidneys and duplication of ureters is described, which, to our knowledge, is a rarely reported variant to date. For this congenital anomaly, a strong suspicion and knowledge of HWWS are essential for a precise diagnosis.

The role of the ERK1/2 signalling pathway in the pathogenesis of female stress urinary incontinence.

OBJECTIVE: To investigate the role of extracellular-regulated protein kinase (ERK)1/2 and phosphorylated (p)-ERK1/2 in the pathogenesis of female stress urinary incontinence (SUI). METHODS: Anterior vaginal wall tissue was collected from women with SUI and control subjects. Immunohistochemistry and Western blotting were performed for p-ERK1/2. Primary vaginal fibroblast cultures were incubated in the presence or absence of PD98059 (an inhibitor of ERK kinase) and levels of collagen I and III mRNA and protein were examined by quantitative reverse transcription-polymerase chain reaction and Western blot, respectively. RESULTS: Levels of p-ERK1/2 were significantly lower in vaginal wall tissue from patients with SUI (n = 10) compared with controls (n = 10). PD98059 treatment significantly reduced levels of collagen I and III mRNA and protein. CONCLUSIONS: Female SUI is associated with reduced levels of p-ERK1/2 compared with controls, and inhibition of the ERK1/2 signalling pathway inhibits collagen type I and III synthesis in vaginal wall fibroblasts.

[Multicenter randomized clinical study of high-intensity focused ultrasound and cortical hormone in the treatment of non-neoplastic epithelial disorders of vulva].

OBJECTIVE: To evaluate the efficacy of high-intensity focused ultrasound (HIFU) and cortical hormone in the treatment of non-neoplastic epithelial disorders of vulva. METHODS: A total of 268 cases with pathologically diagnosed non-neoplastic epithelial disorders of vulva were randomly allocated into two groups of high-intensity focused ultrasound (HIFU) (n = 119) and cortical hormone (n = 124). And 25 cases became lost to follow-ups. Their signs, symptoms and quality-of-life were assessed before treatment, 1 month post-treatment and 3 months post-treatment. And the relationship was analyzed between pathologic type, age, course and efficacies. RESULTS: Their signs, symptoms and quality-of-life improved in both groups after 1 and 3 month. Compared with drug therapy, HIFU showed superior results in lesion amelioration at 1 month with significantly statistical difference and so did lesion amelioration and therapeutic effect at 3 month. And the efficacy of HIFU was better in those with >10-year disease course and pathologically diagnosed lichen sclerosus in 3 months. CONCLUSIONS: HIFU is both safe and effective in the treatment of non-neoplastic epithelial disorders of vulva.

[Outcome prediction of single-period CO(2) laser therapy for vulvar condylomata acuminate].

OBJECTIVE: To evaluate the outcome of CO(2) laser treatment as primary therapy for vulvar condylomata acuminate and examine the risk factors and prediction model of single-period CO(2) laser treatment. METHODS: Between March 2009 and December 2010, a multicenter prospective study was conducted at three 3A hospitals of China (Peking Union Medical College Hospital, Zhejiang Women's Health Hospital & Tongji Hospital). All enrolled patients of vulvar condylomata acuminata received CO(2) laser vaporization as the primary therapy and had return visits at 1, 3 and 6 months individually after treatment. Therapeutic recurrence and side effects were recorded. Logistic regression was used to analyze the associations between demographic or clinical characteristics and the outcome of single-period CO(2) laser treatment and a prediction model was established subsequently. The optimal cutoff value of model was evaluated by area under the receiver operating characteristic curve (AUC ROC). RESULTS: A total of 160 patients completed a 6-month follow-up with a loss rate of 9.1% (16/176). And 131 patients (82%) were cured after the single-period CO(2) laser therapy with a total recovery rate of 94% (150/160). Side effects occurred in 50 (31%) patients with a complete self-recovery within 6 months. The most common side effects were local ulceration, pain and edema. No severe side effect was present. Large area of lesion (>8 cm(2)), vagina involved and unemployment were associated with the failure of single-period treatment while pain symptom was a protective factor of effectiveness. Age, marital status, symptom-free and vaginal involvement were not related with outcome. A prediction model was established as follows: Logit (P(0)) = -1.511+1.573X(1)+1.679X(2)+3.254X(3)-1.685X(4) (X(1)-X(4) representing area of lesion > 8 cm(2), vaginal involvement, unemployment and pain symptom respectively). The optimal cutoff value of P(0) was 0.35 with AUC ROC of 0.816 (P < 0.01). The sensitivity, specificity, positive predictive value and negative predictive value of model were 58.6%, 91.6%, 60.7% and 90.9% respectively. CONCLUSION: CO(2) laser is effective and safe therapy for vulvar condylomata acuminata. A prediction model has been proposed to predict the outcome of single-period CO(2) laser therapy in initially diagnosed patients. It may guide clinical decision-making.

A multicenter study of the clinical characteristics of usual-type vulvar intraepithelial neoplasia in China.

OBJECTIVE: To investigate clinical characteristics of usual-type vulvar intraepithelial neoplasia (uVIN) in China. METHODS: A retrospective review of the records of 64 patients with uVIN was performed at 3 academic hospitals between 2004 and 2010. Patients were assigned to a younger (≤40 years) or an older (>40 years) group. Clinical characteristics of lesions were described and analyzed. RESULTS: Mean patient age was 40.6 years. There was a high proportion of incidental findings (34%), multifocal lesions (64%), variegated lesions (59%), and multiple neoplastic lesions in the lower genital tract (20%). As patient age increased, so did numbers of patients reporting pain (P<0.05). Longer time between symptom onset and uVIN diagnosis, and more multifocal lesions were noted in the older group (P<0.05). Whereas younger patients often presented with cervical intraepithelial neoplasia and uVIN, older patients often presented with intraepithelial neoplasia at uncommon locations (e.g. vagina, anus, and periurethral region) (P<0.05). No differences between the groups were found regarding gross appearance or anatomic location of uVIN lesions (P>0.05). CONCLUSION: Age-specific differences were noted in location of neoplastic lesions in the lower genital tract and time to diagnosis of uVIN. However, the clinical features of uVIN lesions were heterogeneous and non-age specific.

Torsion of a rudimentary uterine horn at 22 weeks of gestation.

Rudimentary uterine horn is an uncommon abnormality of the female reproductive tract. Torsion of rudimentary uterine horn in pregnancy is even rarer. A case of successful excision of distorted rudimentary uterine horn in the second trimester, which caused severe abdominal pain, is described. A congenital absence of the right kidney was discovered simultaneously. The pregnancy continued uneventfully until term delivery.

Long-term outcomes of transvestibular vaginoplasty with pelvic peritoneum in 182 patients with Rokitansky's syndrome.

OBJECTIVE: To evaluate the technical feasibility and anatomical and functional outcomes of one-stage transvestibular vaginoplasty with pelvic peritoneum for the patients with Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome. DESIGN: A retrospective review of prospectively collected data. SETTING: A university hospital. PATIENT(S): A total of 182 women with MRKH syndrome. INTERVENTION(S): Undergoing transvestibular vaginoplasty with pelvic peritoneum. MAIN OUTCOME MEASURE(S): The perioperative results, complications, and anatomical and functional outcomes of transvestibular vaginoplasty with pelvic peritoneum. RESULT(S): The mean operative time was 72.2 minutes (range 55-150 minutes). Average blood loss was 78.5 mL (range 40-170 mL). The only perioperative complication was one case of rectal-vaginal fistula. Thirty-four patients had vault granulation at the neovagina, which healed after trimming and the mean length of the neovagina was 9 cm (range 7-12 cm) without any shrinkage at the follow-up of 3 months after operation. The neovaginal introitus admitted two fingers in width in all patients. Good functional outcomes were found in the patients at follow-up 15 years after surgery with 80% of the cumulative proportion of sexual satisfactory activity. CONCLUSION(S): Transvestibular vaginoplasty with pelvic peritoneum is an effective and feasible approach for women with MRKH syndrome. The procedure has satisfactory long-term anatomical and functional results.