Opportunistic salpingectomy during robotic sacrocolpopexy: Data to support a widely accepted practice.

While surgical outcomes of prophylactic salpingectomy as an ovarian cancer risk reducing measure at the time of hysterectomy for benign indications has already been studied, data has traditionally been extrapolated to surgery for prolapse repair. A retrospective chart review was performed from medical records of patients who had undergone a sacrocolpopexy for pelvic organ prolapse. Variables collected included operation duration, length of hospital stay, readmission within 31 days, estimated blood loss (EBL), number and size of incisions, as well as narcotic use during hospitalization. Additional procedures performed at the time of operation including vaginal or laparoscopic hysterectomy, transobturator sling, anterior or posterior colporrhaphy, cystoscopy, and robotic ventral mesh rectopexy were collected as potential confounding variables. In addition, data to allow examination of pathology results of all fallopian tubes was collected to determine the proportion of pre-malignant and malignant pathology results. Statistical analyses were performed using SAS version 8. Two cohorts were created: (1) Patients who underwent adnexal surgery (bilateral salpingectomy or salpingoopherectomy) at time of the sacrocolpopexy and (2) Patients who underwent a sacrocolpopexy without adnexal surgery. Comparisons were performed with chi-square analysis for discrete variables and group t-tests for continuous level data. Narcotics administered during the immediate post-operative period until discharge was collected for each patient and converted to morphine milligram equivalents (MME) via multiplying the administered dose by the CDC established evidence-based conversion factor. Analysis of covariance (ANCOVA) as well as logistic regression was used to control for confounding variables, including the additional procedures patients had during their operation. An omnibus p-value of 0.05 was used to determine statistical significance for all tests. Due to the exploratory nature of this analysis, there were no corrections applied for multiple comparisons. This data can be used as a basis for researchers to build upon when assessing ovarian cancer primary prevention strategies and associated treatment modalities.

Implant infection after two-stage sacral nerve stimulator placement.

To report our experience with implant infection after two-stage sacral nerve stimulator placement. We reviewed the records of all patients who underwent implantation with a sacral nerve stimulator for the management of refractory cases of urge urinary incontinence, urinary frequency, and non-obstructive urinary retention. Baseline demographic data, interval to the development of infection, and the organism cultured are reported. After stage II neurostimulator placement, 5 out of 37 (13.5%) women required device removal for culture positive wound infections. Patients returned an average of 147.4 days after device implantation with evidence of infection. Infection occurred a minimum of 33 days, a median of 76 days, and a maximum of 461 days after sacral nerve stimulator implantation. The most common pathogen cultured was Staphylococcus aureus. After device removal, all patients resolved their infections. Two patients underwent uncomplicated reimplantation in the contralateral buttock 14 and 16 days after stimulator removal. The risk of infection after tined lead pretest and neurostimulator placement may be higher than previously observed in older techniques.

Use of medroxyprogesterone acetate in the treatment of Müllerian adenosarcoma: a case report.

BACKGROUND: Müllerianadenosarcoma is a rare pelvic malignancy that most commonly arises from the endometrium. These tumors are relatively insensitive to chemotherapy and radiation and are primarily treated by surgical resection. We report a case of müllerian adenosarcoma arising outside of the uterus from a background of endometriosis treated with a combination of surgical resection and medroxyprogesterone acetate. CASE: A 43-year-old woman with a history of endometriosis was diagnosed with advanced extrauterine müllerian adenosarcoma. After suboptimal tumor dubulking surgery she was treated with medroxyprogesterone acetate. Ten months postoperatively she remains without evidence of disease. CONCLUSION: Medroxyprogesterone acetate may be a useful drug in the treatment of advanced müllerian adenosarcoma.