Effect of investigative laparoscopy on bladder pain syndrome: a prospective cohort trial.

INTRODUCTION AND HYPOTHESIS: Chronic pelvic pain is a debilitating condition, and establishing both an etiology and a successful management plan is challenging. Bladder pain syndrome (BPS) is one such etiology, with some studies reporting a prevalence of up to 50% in women with chronic pelvic pain (Van De Merwe et al. Eur Urol 53: 60-67, 2008; Cervigni and Natale Int J Urol 21: 85-88, 2014). This study aimed to assess the impact that investigative laparoscopy with treatment of endometriosis has on bladder pain syndrome in women with and without endometriosis. METHODS: A prospective cohort study was conducted with participants recruited from a tertiary gynecology unit and the private rooms of participating gynecologists. Women included were those scheduled for laparoscopy for investigation of pelvic pain of > 6 months, aged 18-40 years. Each patient completed a preoperative questionnaire, and a standardized study operative report was used to collect laparoscopy findings. Any endometriosis found was treated with excisional surgery. Patients were then reviewed with the same questionnaire at 3, 6 and 12 months post-surgery. RESULTS: A total of 150 patients were included in the trial. Seventy-five percent of patients (n = 112/150) were diagnosed with endometriosis. Of them, 43% (n = 48/112) also had BPS. The overall BPS rate was 43% (n = 64/150). At 12 months, there was a significant reduction in overall pain and pelvic pain in all groups. Of the women with BPS, there was no difference in symptom score reduction between those with endometriosis treated and those without endometriosis. BPS resolved in 42% of women 12 months post-laparoscopy, regardless of whether endometriosis was diagnosed and treated or not. Of the women without BPS preoperatively, 14% developed de novo BPS at 12 months, regardless of whether endometriosis was diagnosed and treated or not. CONCLUSION: Our findings show that BPS improves in the 12 months after investigative laparoscopy and treatment of endometriosis for chronic pelvic pain, regardless of presence or absence of endometriosis.

The outcome of twin pregnancies discordant for trisomy 21.

The management of twin pregnancies discordant for trisomy 21 is dependent on the gestation at diagnosis, chorionicity, and parental preference. Our experience with the management of 15 cases in 1,839 twin pregnancies over a 12-year period is described. Selective termination is not always associated with a successful outcome for the normal co-twin. Two of the three monochorionic twin pregnancies affected by trisomy 21 were discordant. Amniocentesis should be strongly considered rather than chorionic villus sampling in monochorionic twin pregnancies. Pregnancies that continue with a trisomy 21 affected fetus are at risk of polyhydramnios and premature labor.