Resección histeroscópica de septo uterino conformado por mioma submucoso / Hysteroscopy Resection of the Uterine Septum Due To Submucosal Myoma

Las malformaciones uterinas congénitas presentan una baja prevalencia en la población general (0,5-6,7 por ciento), el útero septo es la más frecuente. Estas enfermedades pueden afectar a los resultados reproductivos de las pacientes, así como aumentar la incidencia de abortos de repetición, presentaciones fetales anómalas o partos pretérminos. De la misma forma, los miomas uterinos submucosos también pueden producir alteraciones de la fertilidad, aunque la sintomatología más relacionada con los mismos es el sangrado. Constituyen el tumor benigno más frecuente del aparato genital femenino. El diagnóstico de estas patologías puede realizarse mediante pruebas de imagen como la ecografía transvaginal y la resonancia magnética, aunque la visualización directa vía histeroscópica sigue siendo de elección. Esta técnica constituye, además, la primera opción terapéutica, ya que se puede realizar tanto la resección del septo uterino como la miomectomía, sin apenas complicaciones y mediante una técnica quirúrgica segura y poco invasiva. El tratamiento histeroscópico está especialmente indicado en pacientes sintomáticas, con esterilidad o abortos de repetición, incluso antes de iniciar terapias de reproducción asistida. En el siguiente trabajo exponemos el caso de una paciente que presentaba un septo uterino constituido en su mayor parte por un leiomioma submucoso tratado vía histeroscópica; siendo un caso muy raro, dada la infrecuente asociación entre ambas patologías(AU)

Congenital uterine malformations present low prevalence in the general population (0.5-6.7 percent), and uterus septum is the most frequent. These pathologies can affect the reproductive outcomes of patients, as well as increase the incidence of repeating abortions, abnormal fetal presentations or preterm deliveries. In the same way, submucosal uterine fibroids can also produce alterations in fertility, although the most related symptomatology is bleeding. They are the most frequent benign tumor of the female genital tract. Diagnosis can be carried out through imaging tests such as transvaginal ultrasound and magnetic resonance imaging, although direct visualization, via hysteroscopy, is still the preferred option. This technique is also the first therapeutic option, since both, resection of the uterine septum and myomectomy can be performed with few complications and a safe and minimally invasive surgical technique. Hysteroscopy is especially indicated in symptomatic patients, with sterility or repeated abortions, even before initiating assisted reproduction therapies. In the following paper, we present the case of a patient who presented a uterine septum formed mostly by a submucosal leiomyoma. She was treated by hysteroscopy. This case is very rare given the infrequent association between both pathologies(AU)

Safety and patients' satisfaction after hysteroscopic sterilisation.

The aim of this study was to understand the potential complications of the Essure® device as well as the factors influencing its onset and patient satisfaction. We present a 9-year descriptive prospective study that included 1068 patients. The device was placed in 1056 of them (98.8%); 894 had no pain or mild pain during the insertion and only 12 patients experienced pain greater than menstrual pain. The proportion of patients without pain was greater in the group that took NSAIDs or NSAIDs and BZD and the unmedicated group had the highest rate of severe pain (p = .00). In all, 161 of the 1064 patients who had the Essure® inserted reported having an adverse effect during the 3-months post-insertion (pelvic pain or discomfort). The mean score out of 10 attributed to this method was 9.06 (S = 1.11). We concluded that the Essure® shows a low rate of complications and users showed a high degree of satisfaction. Impact statement What is already known on this subject: There are few international publications on Essure®. When we conducted a search in PubMed for the term 'Essure', we obtained 221 publications. When we added the terms 'Essure and complications', we obtained 20 publications, and when we increased the restriction including 'satisfaction', we obtained seven; thus, the uniqueness of our study. What the results of this study add: We present a 9-year descriptive prospective study that included 1068 patients. The aim of this study was to understand the potential complications of the Essure® device (Bayer, Whippany, NJ), as well as factors that can influence its onset and the patient satisfaction. The device was placed in 1056 of the patients (98.8%); 894 had no pain or mild pain during the insertion and only 12 patients experienced pain greater than menstrual pain. The proportion of patients without pain was greater in the group that took NSAIDs or NSAIDs and BZD and the unmedicated group had the highest rate of severe pain (p=.00). What the implications are of these findings for clinical practice and/or further research: Our study shows a low rate of complications with Essure®, mild and transient in most cases, as well as a high degree satisfaction. Nevertheless, given the few published studies on this device, we believe that long-term follow-up is needed.

Torsión aislada de trompa de Falopio en paciente sometida a bloqueo tubárico bilateral / Isolated Fallopian tube torsion in a patient with bilateral tube blockage

La torsión aislada de la trompa de Falopio es un motivo infrecuente de consulta en Ginecología. La clínica que produce es sumamente inespecífica, dificultando mucho la realización de un diagnóstico de sospecha y de un tratamiento precoz (AU)

Isolated torsion of the fallopian tube is a rare reason for seeking consultation in gynaecology. Symptoms are non-specific, which hampers its presumptive diagnosis and early treatment (AU)

Análisis de los factores que influyen en la aparición de efectos adversos en la versión cefálica externa / Analysis of factors influencing the development of adverse effects in the external cephalic version

Objetivos. Establecer la relación existente entre los efectos adversos de la versión cefálica externa (VCE) y diferentes variables relacionadas con la técnica. Material y método. Estudio prospectivo que incluyó a 180 gestantes a las que se realizó una VCE. Analizamos los efectos adversos fetales y maternos observados, y su relación con el resultado final de la versión, la experiencia del obstetra, el tiempo empleado en la maniobra, el número de intentos realizados en la misma sesión y el fármaco empleado como relajante uterino. Resultados. Se obtuvo el éxito de la VCE en el 32,6% de las primíparas y en el 79,19% en multíparas. La tasa global de efectos adversos fue del 28,33%, y fue superior en las versiones que fracasaron, en las de mayor número de intentos fallidos, las de mayor duración de la maniobra y en las que fue utilizado ritodrina como útero-relajante. Conclusiones. Se obtiene una mayor probabilidad de éxito y una menor tasa de efectos adversos en las VCE en las que se realiza un único intento, con una duración total de la maniobra inferior a 5min y empleando salbutamol como relajante uterino(AU)

Objectives. To identify the association between the adverse effects of the external cephalic version (ECV) and several variables related to the technique. Material and method. We performed a prospective study in 180 pregnant women who delivered through the ECV. We analyzed fetal and maternal adverse effects and their association with the final result of the version, the experience of the obstetrician, the time used in the maneuver, the number of attempts performed in the same session, and the drug used as a uterine relaxant. Results. The ECV was successfully performed in 32.6% of primiparas and 79.19% of multiparas. The overall rate of adverse effects was 28.33%, and was higher in versions that failed, those with a greater number of failed attempts, those with longer duration and those in which ritodrine was used as a uterine relaxant. Conclusions. The factors increasing the probability of success and reducing the rate of adverse effects in ECV are a single attempt at the maneuver, total duration of the maneuver of less than 5minutes, and use of salbutamol as a uterine relaxant(AU)

Agenesia ovárica unilateral: utilidad de la histerosalpingografía para el diagnóstico etiológico. A propósito de un caso / Unilateral ovarian agenesis: usefulness of hysterosalpingography for etiological diagnosis. A case report

La ausencia de ovario y trompa unilateral es un hallazgo extremadamente raro. Sus posibles etiologías son la ausencia congénita y la torsión subaguda con autoamputación. Se presenta el caso de una paciente que consulta por infertilidad y en el que tras observar repetidamente mediante ecografía una imagen quística en el anejo derecho, y en la histerosalpingografía una imagen compatible con la existencia de la trompa homolateral, se halló en la laparoscopia una ausencia de ovario derecho con la presencia de un seudoquiste y sin una imagen clara de trompa de Falopio. Se realiza una revisión de la bibliografía y se propone como posible etiopatogenia una torsión asintomática con posterior necrosis del ovario

Unilateral absence of a uterine tube is an extremely rare finding. There are two possible etiopathogenic causes: the absence may be congenital or the result of an asymptomatic torsion of the uterine tube. We present the case of a woman who consulted for infertility. Sonography repeatedly showed a cystic image in the right adnexal area, while hysterosalpingography showed an image compatible with the presence of the homolateral uterine tube. However, laparoscopy did not clearly show the uterine tube, and instead of locating the right ovary, a pseudocyst was found. A review of the literature is provided and asymptomatic torsion with subsequent necrosis of the ovary as the possible etiopathogenesis of this case is proposed