Use of Shear Wave Elastography to Evaluate Stress Urinary Incontinence in Women.

OBJECTIVE: To compare the shear wave elastography (SWE) values of perineal tissues in female patients with stress urinary incontinence and those without incontinence. STUDY DESIGN: Prospective case control study. PLACE AND DURATION OF STUDY: University of Health Sciences, Adana City Training and Research Hospital, Adana, Turkey from March 2019 to March 2020. METHODOLOGY: Seventy women with stress urinary incontinence ranging between 40-70 years; and 30 women of similar age and weight without complaints of incontinence were selected as cases and control group, respectively. SWE values of the external urethral sphincter, bladder neck, mid-urethral and pubococcygeal muscle regions were measured dynamically, both at rest and during Valsalva manoeuver by transperineal ultrasonography. Moreover, the medial pubic symphysis of the participants was taken as a fixed point and the angle between the bladder neck and urethra was measured at rest and during Valsalva. Patients with incontinence were divided into groups, mild and severe, according to the bladder stress test results. RESULTS: The angle change was statistically significantly higher in the severe and mild groups than the control group (p <0.001). There was no statistically significant difference between the bladder neck region elastography values in Valsalva manoeuver between the control group and the mild group, but the difference in the severe group was statistically significantly lower (p = 0.005). No statistically significant difference was found between the control group and the mild group in terms of the mid-urethral region values at rest, but the difference in the severe group was statistically significantly lower (p ˂0.001). CONCLUSION: SWE is a promising new imaging method in the evaluation of urethral hypermobility in stress urinary incontinence. Key Words: Ultrasonography, Shear wave elastography, Stress urinary incontinence, Transperineal ultrasonography.

Acute appendicitis in pregnancy: 50 case series, maternal and neonatal outcomes.

BACKGROUND: During pregnancy, the most common indication for non-obstetric surgery in acute abdomen is appendicitis. In pregnancy, appendicitis may be confused with pregnancy-related pathologies and may cause a delay in diagnosis or unnecessary surgery. The present study aims to evaluate the maternal and neonatal outcomes of patients undergoing appendectomy during pregnancy. METHODS: This study was designed retrospectively between 2011-2017. Appendicitis detection rates, admission and laboratory features, operation results and obstetric results were evaluated in pregnant women who underwent surgery for a preliminary diagnosis of acute appendicitis. RESULTS: The findings showed that 2593 patients underwent an appendectomy, 1154 of them were women and 50 of them were pregnant. Negative laparotomy was detected in 12 (16%) patients. Six (12%) of these 50 patients had a laparoscopic appendectomy and 44 (88%) had an appendectomy with laparotomy. The mean time to operation after admission to hospital was 10.5±11 hours. No maternal mortality was observed. Preterm labor occurred in four (8%) patients. Two patients (4%) were in the second trimester and two patients (4%) were in the third trimester. Two (4%) newborns born in the second trimester died postpartum. One of these newborns had multiple anomalies. Appendectomy was not characterized by an increased risk of perinatal mortality. CONCLUSION: Delay in the diagnosis and surgery of acute appendicitis during pregnancy may increase the risk of perinatal mortality and should not be delayed in diagnosis and surgery in pregnancy.

Surgical Removal of an Extrauterine Device Migrating to Appendix.

Intrauterine devices (IUDs) remain highly effective reversible family planning methods in developing countries. We aimed to report one of the complications of extrauterine and intrauterine devices. A 44-year-old woman was admitted to our hospital with mislocated intrauterine device and abnormal uterine bleeding. Extrauterine IUD device was proven by ultrasound and X-ray. She had normal blood test count with a negative pregnancy test. There are several cases of complications with intrauterine devices, but this is the first case report about an extrauterine IUD embedded by inflame enlarged appendix presenting with abnormal uterine bleeding. Although intrauterine devices are a common safe method for contraception, there is no risk-free insertion even with advanced ultrasounds. A regular self-examination should be taught to the patients and ultrasonography should be performed in the follow-up of the patients especially for inserted devices during lactation period. Extrauterine IUDs can be successfully removed by laparotomy.