ABSTRACT
Controversies remain regarding the preferred treatment strategy for central introital dyspareunia. The primary goal of this retrospective study was to evaluate the short- and long-term outcomes after operative management of central introital dyspareunia by widening hymenoplasty. In total, 513 patients were included, with a follow-up time of 10 years. We assessed the repair of sexual activities, quality of sexual life, and the prevalence of pregnancies after the procedure. In addition, general health status was assessed using the EuroQol-5D questionnaire. Of the 513 women operated on during the period of January 2009 until December 2019, 380 (74%) agreed to participate by sending a valid response. Eighty-seven percent of the respondents mention no to moderate pain for longer than one week after the procedure, while 9.5% and 4% of patients recalled the procedure as severely or extremely painful, respectively. Seventeen percent of patients recalled a complication; 13.2% reported prolonged healing or postoperative pain, 4.7% reported infection, and 2.4% reported bleeding. Twelve months after surgery, 72% experienced no or only slight pain during penetration. We can conclude that widening plasty of the posterior hymenal rim and vestibulum, performed as an ambulatory care procedure under local anesthesia, resolves more than 70% of the central introital pain problems one year after surgery.
ABSTRACT
BACKGROUND: Possible transtubal spillage of malignant cells is a major concern in fluid instillation sonography, as it is in hysteroscopy. This study aims to compare the transtubal flow of gel and saline and validate the clinical hypothesis that application of fluids with higher viscosity causes less spillage. METHODS: Randomized controlled in vitro trial comparing gel and saline infusion on 15 tissue specimens after hysterectomy with bilateral salpingectomy. Instillations are performed with saline and gel dyed with a 1% ink solution. Qualitative assessment of tubal spill is investigated as primary outcome. Secondary outcomes are instillation-volume and -pressure, assessed by measuring endometrial cavity dilation at in vitro ultrasound examination and subjective numeric 10-point scoring of the instillation pressure by a dedicated examiner. RESULTS: Tubal flow was more often observed during saline instillation (odds ratio 4.88, P = 0.008). Median subjectively assessed instillation pressures were nine arbitrary units for gel and three for saline (P < 0.001). Tubal flow occurred from 2 cc onward in the saline group versus five cc in the gel instillation group. Cavitary dilation did not differ between both groups. CONCLUSION: Gel instillation sonography is in vitro associated with less tubal flow and therefore could be a safer diagnostic test compared to saline infusion sonography or hysteroscopy. In vivo studies are necessary to confirm these results.
ABSTRACT
Open reposition and internal fixation (ORIF) is the reference standard for unstable Arbeitsgemeinschaft für Osteosynthesefragen (AO)-type 44-B ankle fractures. Age, comorbidity, delayed-staged surgery, and length-of-stay (LOS) are all factors that presumably correlate positively with health care costs. We performed an exploratory analysis of the health care costs associated with the treatment of this type of fracture and hypothesized that these costs will be significantly greater for the elderly. A total of 217 patients with an acute AO type 44-B ankle fracture were included. We studied 14 variables, and 5 main cost categories were defined. The health care costs associated with the treatment of ankle fractures in the present study constituted more than one half (53%) of the hospitalization costs, which, in turn, were strongly related to the LOS. Delayed-staged surgery and age were the most important clinical variables driving the total health care costs and LOS (p < .001). The median LOS before ORIF was 6 times greater (12 versus 2 days) for patients treated using a delayed-staged surgery protocol. The cutoff age above which the costs differed significantly was 65 years. Thus, the median total health care costs for the treatment of these fractures were doubled in the older group ($9207 versus $4559), mainly owing to a 2 times greater LOS before ORIF (2 versus 4 days) and 3 times greater total LOS (4 versus 12.5 days) in the elderly. Surprisingly, the complication rate was equal (27.7% versus 29.3%) in the 2 groups. Therefore, to decrease the total health care costs, we should focus on a reduction of the costly LOS before ORIF in the elderly population.